Why is the study important? 

These data suggest that up to 5 years, self-expanding TAVR devices appear to be more durable than surgical aortic valve replacements (SAVR). 

Should I change my practice because of these findings? 

This study should change the way we discuss aortic valve durability with patients deciding between TAVR and SAVR. 

What question was the study supposed to answer? 

What is the 5-year durability of the CoreValve/Evolut (Medtronic) self-expanding TAVR valve in severe AS patients compared to SAVR. 

What did the study show? 

Data was pooled from the randomized SURTAVI intermediate risk trial and CoreValve US High-Risk Pivotal trial as well as the CoreValve US Extreme-Risk Study and the CoreValve Continued Access Study.  Structural valve deterioration was defined as a change of >= 10mmHg and a mean gradient >= 20 mmHg or new onset of moderate or greater intra-prosthesis aortic insufficiency.  The study showed the rate of structural valve deterioration at 5 years was 4.38% with SAVR versus 2.7% with self-expanding TAVR (p=0.0095).   The effect seemed to be greater for valves <= 23 mm in diameter. Structural valve deterioration was associated with an increased risk of all-cause mortality (HR 1.98; 95% CI 1.42-2.76) and cardiovascular mortality (HR 1.82; 95% CI 1.19-2.84). 

How good was the approach/methodology? 

Data presented at ACC.22 and full text manuscript not yet available for review.

All editors: Jared O'Leary, MD