Key result
TAVI in very severe AS shows a non-significant trend toward lower long-term mortality versus severe AS.
Why the study?
Very severe aortic stenosis has unfavourable outcomes untreated or after surgical replacement, but previous studies suggest outcomes after TAVI may be similar or paradoxically better than in severe aortic stenosis.
Does TAVI yield different procedural and long-term mortality outcomes in patients with very severe aortic stenosis compared to severe aortic stenosis?
Cohort (n=192)
No
Does TAVI yield different procedural and long-term mortality outcomes in patients with very severe aortic stenosis compared to severe aortic stenosis?
Effect estimate: HR 0.668 (95% CI 0.430-1.038)
p-value: p=0.073
Patients with very severe aortic stenosis have comparable or potentially better long-term survival after TAVI compared to those with severe aortic stenosis, suggesting TAVI should not be withheld in this high-risk group.
Supports TAVI feasibility in very severe aortic stenosis; leaves open survival benefit versus severe disease.
Background: Very severe aortic stenosis (VSAS) is a critical condition with unfavourable clinical outcomes if left untreated or treated by surgical valve replacement. In contrast, after transcatheter valve implantation (TAVI) outcomes seem to be similar or - paradoxically - even better compared to severe aortic stenosis (SAS), as indicated by previous studies. Methods: Data of patients from a single centre who underwent TAVI were retrospectively analysed. Patients with concordant AS (n = 475) were divided into SAS (n = 379) and VSAS (n = 96) groups. These groups are compared in terms of procedural (safety) and long-term (efficacy) outcomes, using propensity score matching. In addition, a review of relevant literature is provided. Results: After propensity score matching, 96 patients remained in each group. Procedural outcomes did not differ significantly between VSAS and SAS groups. Cox proportional hazards regression analysis showed a favourable trend toward lower overall mortality within a mean follow-up of 42 months after TAVI in the VSAS group (hazard ratio, HR, 0.668; 95 % confidence interval, CI, 0.430-1.038). This difference did not reach statistical significance (p = 0.073), however, it was significant in the subgroups of females (p = 0.045) and patients with NYHA class III (p = 0.043). Conclusion: Our analysis confirms - in line with previous studies - that patients with VSAS represent a substantial subgroup and have at least as favourable or - paradoxically -even better clinical results after TAVI compared to patients with SAS. Therefore, TAVI should not be withheld from these patients.
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Hammerer et al. (2025) conducted a cohort in Severe and very severe aortic valve stenosis (n=192). Transcatheter aortic valve implantation (TAVI) in very severe aortic stenosis vs. Transcatheter aortic valve implantation (TAVI) in severe aortic stenosis was evaluated on Long-term overall mortality (HR 0.668, 95% CI 0.430-1.038, p=0.073). Transcatheter aortic valve implantation in patients with very severe aortic stenosis resulted in a favorable but non-significant trend toward lower long-term overall mortality compared to patients with severe aortic stenosis (HR 0.668).
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