Long-Term Outcomes of Transcatheter Aortic Valve vs. Surgical Aortic Valve Replacement—Coverage of EuroPCR 2024 | SCAI

Why is this study important?

  • TAVR (transcatheter aortic valve replacement) is less invasive compared to SAVR (surgical aortic valve replacement) in the treatment of severe aortic stenosis.
  • TAVR appears to be effective and safe, but its long-term benefits and outcomes as compared to SAVR are unclear at the current time.

What question was this study supposed to answer?

  • A meta-analysis of randomized control trials was performed comparing the long-term outcomes of patients who underwent TAVR versus those who underwent SAVR.
  • The trials were grouped into high-risk, intermediate-risk, and low-risk categories as per surgical risk. The TAVR arm was further categorized as self-expanding valve and balloon-expandable valve categories.

What did the study show?

  • Seven trials (n=7785 patients) were included in the meta-analysis. Mean trial follow-up was 5.76 ± 0.073 years.
  • There was no significant difference in death or disabling stroke in TAVR patients as compared to SAVR patients (HR 1.02, 95% CI 0.93–1.11, p=0.70).
  • There were no significant differences in mortality between the TAVR patients and SAVR patients.
  • TAVR resulted in higher pacemaker implantation (self-expandable valves had a significantly higher rate than balloon-expandable valves) and moderate-to-severe paravalvular leaks compared to SAVR.
  • The self-expanding TAVR valves were associated with lower valve gradients but higher pacemaker implantation rates than balloon-expandable TAVR valves.
  • The above results were consistent across all surgical risk (high risk, intermediate risk, and low risk) categories.
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