What is the clinical evidence from this study?

Study design: Cohort. Population: severe aortic stenosis (n=373). Intervention: Transcatheter aortic valve implantation (TAVI) vs. Conservative management. Primary outcome: All-cause survival (HR 0.38, 95% CI 0.28 to 0.50, p=<0.001).

What question did this study set out to answer?

This study aims to evaluate the long-term outcomes of severe aortic stenosis management strategies involving TAVI and conservative treatments.

February 2, 2026Open Heart2 citationsOpen Access

Multidisciplinary team-guided management of severe aortic stenosis: 5-year outcomes following TAVI versus conservative treatment

Q: What are the key findings of this study?

TAVI is associated with a substantial and durable survival advantage compared to conservative management in patients with severe aortic stenosis.

Q: What does this research mean for the field?

TAVI is associated with a substantial and durable survival advantage compared to conservative management in patients with severe aortic stenosis. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Q: What question did this study set out to answer?

This study aims to evaluate the long-term outcomes of severe aortic stenosis management strategies involving TAVI and conservative treatments.

JMJames M. ManningCentre for Inflammation Research LKLouis KoiziaSt. Catherine University MDMelanie Dani

Key Result

TAVI is associated with a substantial and durable survival advantage compared to conservative management in patients with severe aortic stenosis.

Key Points

This study aims to evaluate the long-term outcomes of severe aortic stenosis management strategies involving TAVI and conservative treatments.
Conducted a retrospective cohort study of severe aortic stenosis patients at a tertiary center.
Patients were categorized as TAVI or conservatively managed.
Collected demographic, clinical, and frailty data including comorbidity indices.
Analyzed survival using Kaplan-Meier estimates and Cox proportional hazards modeling.
Patients undergoing TAVI had significantly younger ages (81.3 years) compared to non-TAVI patients (83.5 years).
Significant survival advantage at 5 years for TAVI (44.9%) versus conservative management (12.1%; p<0.001).
Median survival was 53 months for TAVI patients compared to 20 months for non-TAVI patients.
TAVI was independently associated with reduced mortality (HR 0.38).

Study Design

Type

Cohort (n=373)

Multicenter

Structured PICO

Does transcatheter aortic valve implantation (TAVI) improve long-term survival compared to conservative management in patients with severe aortic stenosis discussed at a multidisciplinary team meeting?

Population

373 patients with severe aortic stenosis discussed at a transcatheter aortic valve implantation (TAVI) multidisciplinary team (MDT) meeting at a tertiary UK centre. TAVI group (n=178) mean age 81.3 years; conservatively managed group (n=195) mean age 83.5 years.

Intervention

Transcatheter aortic valve implantation (TAVI)

Comparator

Conservative management (non-TAVI)

Outcome

All-cause survival measured in months from the date of MDT review (non-TAVI cohort) or TAVI procedure (TAVI cohort) to death or censoring at last follow-up over a 5-year periodhard clinical

In patients with severe aortic stenosis, TAVI confers a substantial and durable 5-year survival advantage over conservative management, highlighting the poor prognosis of untreated severe AS.

Main Result

Effect estimate: HR 0.38 (95% CI 0.28 to 0.50)

Absolute Event Rate: 44.9% vs 12.1%

p-value: p=<0.001

Limitations

Retrospective design limits generalizability and may introduce selection bias.
No randomization between treatment strategies.
Incompleteness in capturing cause-specific mortality and echocardiographic parameters.
Study period predates newer-generation TAVI devices, potentially underestimating contemporary outcomes.

Abstract

Objective Multidisciplinary team (MDT) meetings are central to treatment decisions in aortic stenosis (AS), particularly for borderline or high-risk patients. This study evaluates long-term, real-world outcomes according to MDT-selected management strategy within routine clinical practice in this clinically important patient group. Methods We conducted a retrospective cohort study of all patients with severe AS discussed at a transcatheter aortic valve implantation (TAVI) MDT at a tertiary UK centre between January 2014 and December 2016. Patients were categorised as TAVI or non-TAVI (conservatively managed). Demographic, clinical and frailty data were collected, including Charlson Comorbidity Index, Clinical Frailty Scale (CFS) and number of prescribed medications. Survival was analysed using Kaplan-Meier estimates and Cox proportional hazards modelling adjusted for age, sex, frailty, comorbidity burden and medication count. Results A total of 373 patients were included (TAVI=178; non-TAVI=195). Patients undergoing TAVI were younger (81.3 years vs 83.5 years; p=0.01) and less frail (CFS 3.9 vs 4.9; p<0.01). Survival at 1 year, 2 years and 5 years was significantly higher following TAVI (87.6%, 74.7%, 44.9%) compared with conservative management (60.8%, 44.2%, 12.1%; p<0.001). Median survival was 53 months after TAVI versus 20 months without intervention. On multivariable analysis, TAVI was independently associated with reduced mortality (HR 0.38, 95% CI 0.28 to 0.50; p<0.001). Conclusions In patients with severe AS discussed at MDT, TAVI was associated with a substantial and durable survival advantage compared with conservative management. These findings highlight the poor prognosis of untreated severe AS and support systematic inclusion of conservatively managed patients in interventional registries to better inform MDT deliberation and shared decision-making.

اسأل الذكاء الاصطناعي

Bookmark

View Full Paper