Early Valve Replacement vs Surveillance in Moderate Aortic Stenosis: Meta-Analysis of Randomized and Observational Evidence

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

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