Key result
TAVR linked to ~51% higher all-cause mortality versus surgical replacement in severe aortic stenosis.
Why the study?
Limited data are available from randomized trials comparing outcomes between TAVR and surgery across different risk profiles with follow-up >2 years.
Does transcatheter aortic valve replacement reduce all-cause mortality compared to surgical aortic valve replacement in patients ≥65 years with severe, symptomatic aortic stenosis?
Cohort (n=18,882)
Yes
Does transcatheter aortic valve replacement reduce all-cause mortality compared to surgical aortic valve replacement in patients ≥65 years with severe, symptomatic aortic stenosis?
Effect estimate: propensity score-matched HR 1.510 (95% CI 1.403-1.625)
p-value: p=<0.001
In a large, real-world Austrian cohort with >2 years follow-up, TAVR was associated with significantly higher all-cause mortality compared to surgical aortic valve replacement in patients ≥65 years with severe aortic stenosis.
TAVR linked to higher mortality in this cohort warrants caution for lower-risk patients; leaves open whether RCTs will confirm or refute in contemporary practice.
Background Limited data are available from randomized trials comparing outcomes between transcatheter aortic valve replacement (TAVR) and surgery in patients with different risks and with follow-up >2 years. Objective In this large, population-based cohort study, long-term mortality and morbidity were investigated in patients undergoing aortic valve replacement (AVR) for severe aortic stenosis using a surgically implanted bioprosthesis (sB-AVR) or TAVR. Methods Individual data from the Austrian Insurance funds from 2010 through 2020 were analysed. The primary outcome was all-cause mortality, assessed in the overall and propensity score–matched populations. Secondary outcomes included reoperation and cardiovascular events. Results From January 2010 through December 2020, a total of 18 882 patients underwent sB-AVR (n=11 749; 62.2%) or TAVR (n=7133; 37.8%); median follow-up was 4.0 (interquartile range 2.1–6.5) years (maximum 12.3 years). The risk of all-cause mortality was higher with TAVR compared with sB-AVR: hazard ratio (HR) 1.552, 95% confidence interval (CI) 1.469–1.640, p<0.001; propensity score–matched HR 1.510, 1.403–1.625, p<0.001. Estimated median survival was 8.8 years (95% CI 8.6–9.1) with sB-AVR vs 5 years (4.9–5.2) with TAVR. Estimated 5-year survival probability was 0.664 (0.664–0.686) with sB-AVR vs 0.409 (0.378–0.444) with TAVR overall, and 0.690 (0.674–0.707) and 0.560 (0.540–0.582), respectively, with propensity score matching. Other predictors of mortality were age, sex, previous heart failure, diabetes, and chronic kidney disease. Conclusions In >2-year follow-up, selection for TAVR was significantly associated with higher all-cause mortality compared with sB-AVR in patients ≥65 years with severe, symptomatic aortic stenosis.
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Auer et al. (2023) conducted a cohort in Severe aortic stenosis (n=18,882). Transcatheter aortic valve replacement (TAVR) vs. Surgically implanted bioprosthesis (sB-AVR) was evaluated on All-cause mortality (propensity score-matched HR 1.510, 95% CI 1.403-1.625, p=<0.001). TAVR was associated with higher all-cause mortality compared to surgical replacement in severe aortic stenosis (propensity-matched HR 1.510; 95% CI 1.403-1.625; P<0.001).
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