{
  "abstract": "BACKGROUND: Moderate aortic stenosis (AS) is associated with excess mortality, and 2 randomized trials have tested early transcatheter aortic valve replacement (TAVR). OBJECTIVES: The authors sought to estimate the effects of early TAVR vs clinical surveillance and to compare randomized with observational estimates. METHODS: Six databases and registries were searched through November 3, 2026. Adjusted observational studies were synthesized separately from trials. Certainty was rated with GRADE. RESULTS: Two trials (922 patients; TAVR UNLOAD, n = 178, HF with reduced ejection fraction; PROGRESS, n = 744, 96.4% symptomatic) and 7 cohorts were included. Early TAVR did not detectably change death over approximately 2 years (HR: 1.05; 95% CI: 0.74-1.49; low certainty), with one-fifth of the deaths needed to detect a 20% reduction. Heart failure (HF) hospitalization was lower (RR: 0.53; 95% CI: 0.36-0.77; low certainty), or 70 fewer patients per 1,000 at 2 years. New pacemakers were more frequent (PROGRESS: 17.3% vs 9.3%; moderate certainty). About half of surveillance patients underwent valve replacement within 2 years. Observational cohorts estimated a 48% mortality reduction (HR: 0.52; 95% CI: 0.43-0.64; very low certainty), which differed from the randomized estimate (ratio of HRs: 2.01; 95% CI: 1.37-2.95). CONCLUSIONS: In older, predominantly symptomatic patients with moderate AS, early TAVR may make little or no difference to 2-year mortality and may reduce HF hospitalization, at the cost of more pacemakers. Because about half of patients under surveillance receive a valve within 2 years, the decision largely concerns timing. Observational survival estimates should not guide practice.",
  "abstract_shown": true,
  "affiliations": [
    "Lebanese American University Gilbert and Rose-Marie Chagoury School of Medicine"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "A. Majed"
    },
    {
      "name": "P. Kmeid"
    },
    {
      "name": "A. Safa"
    },
    {
      "name": "H. Kahwaji"
    },
    {
      "name": "H. Safieddine"
    },
    {
      "name": "G. Ghanem"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/arrqd8dsgptym.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.11.04.26367266",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.11.04.26367266v1.full",
  "id": "arrqd8dsgptym",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.11.04.26367266v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "cardiovascular medicine"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.11.04.26367266v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-04",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/arrqd8dsgptym.ris",
  "sources": [
    {
      "first_seen": "2026-11-06T00:21:06Z",
      "native_id": "10.64898/2026.11.04.26367266",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.11.04.26367266v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:cardiovascular medicine",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Early Valve Replacement vs Surveillance in Moderate Aortic Stenosis: Meta-Analysis of Randomized and Observational Evidence",
  "title_text": "Early Valve Replacement vs Surveillance in Moderate Aortic Stenosis: Meta-Analysis of Randomized and Observational Evidence",
  "type": "preprint",
  "updated_at": "2026-11-06T00:21:06Z",
  "url": "https://research.draconitic.com/paper/arrqd8dsgptym",
  "venue": "medRxiv",
  "versions": []
}