Transcatheter versus minimally invasive surgical aortic valve replacement: A propensity score-matched analysis in low-risk patients

Objective: Minimally invasive aortic valve replacement (MIAVR) and transcatheter aortic valve replacement (TAVR) represent less-invasive alternatives to conventional surgical aortic valve replacement. In contrast to Society of Thoracic Surgeons (STS) Database data revealing <10% of all surgical aortic valve replacement procedures are performed via a minimally invasive approach, our center performs a high volume of MIAVR procedures. This propensity-score matched study aims to compare the outcomes of MIAVR versus TAVR in low-risk patients (STS Predicted Risk of Mortality <4%). Methods: We identified 476 low-risk patients who underwent MIAVR via a right anterolateral minithoracotomy and 679 low-risk patients who underwent TAVR at our institution between 2017 and 2024. In a total of 1155 cases, propensity score analysis performed at a ratio of 1:1 yielded 295 matched pairs. There was no significant difference in early mortality or stroke rates between the 2 groups. Conclusions: To our knowledge, this is the first propensity-score matched comparison of clinical outcomes in low-risk patients undergoing MIAVR versus TAVR, revealing that MIAVR could provide lower rates of permanent pacemaker implantation, paravalvular leak, and aortic regurgitation, without any increase in short-term mortality or stroke. Future prospective or randomized controlled trials are needed to validate these results.