Key result
SAVR linked to ~89% lower five-year cardiac mortality versus TAVR in low-risk aortic stenosis.
Why the study?
The study was conducted to compare clinical outcomes between isolated SAVR and TF-TAVR in low-risk patients with aortic stenosis.
Does isolated surgical aortic valve replacement improve clinical outcomes compared to transfemoral transcatheter aortic valve replacement in low-risk patients with severe aortic stenosis?
Cohort (n=696)
Yes
Does isolated surgical aortic valve replacement improve clinical outcomes compared to transfemoral transcatheter aortic valve replacement in low-risk patients with severe aortic stenosis?
Hazard Ratio: 8.89 (95% CI 2.68–29.53)
Absolute Event Rate: 1.3% vs 18.9%
p-value: p=<0.001
These observational data should not yet change TAVR preference in low-risk AS; they leave open whether SAVR confers a true long-term survival advantage.
PURPOSE: This study aimed to compare the clinical outcomes of isolated surgical aortic valve replacement (SAVR) and transfemoral (TF)-transcatheter aortic valve replacement (TAVR) in low-risk aortic stenosis (AS) patients. METHODS: A total of 696 low-risk (Society of Thoracic Surgeons score <4%) AS patients underwent isolated SAVR or TF-TAVR at five centers. After 1:1 propensity score matching, 159 pairs were identified. Early and follow-up events, including cardiac mortality and major adverse cardiac and cerebrovascular events (MACCE: all-cause mortality, heart failure admission, reoperation, prosthetic valve endocarditis, and stroke), were compared. RESULTS: Baseline characteristics are similar between the matched groups. There were no 30-day cardiac mortalities in either group. All-cause mortality and MACCE at 30 days did not differ. During 5-year follow-up (median 3.1 [range 0-7.2] years), the incidence of cardiac mortality (1.3% vs. 18.9%; adjusted hazard ratio [aHR], 8.89; 95% confidence interval [CI], 2.68-29.53; P <0.001), all-cause mortality (4.2% vs. 33.9%; aHR, 8.56; 95% CI, 3.41-21.45; P <0.001), and MACCE (25.1% vs. 47.0%; aHR, 2.36; 95% CI, 1.54-3.63; P <0.001) were lower in the SAVR group than in the TAVR group. CONCLUSIONS: Isolated SAVR demonstrated better outcomes in low-risk AS patients. TAVR in this subset should be chosen carefully.
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Handa et al. (2024) conducted a cohort in Severe aortic stenosis (low-risk) (n=696). Isolated surgical aortic valve replacement (SAVR) vs. Transfemoral transcatheter aortic valve replacement (TF-TAVR) was evaluated on 5-year cardiac mortality (aHR 8.89, 95% CI 2.68-29.53, p=<0.001). Isolated surgical aortic valve replacement reduced 5-year cardiac mortality (1.3% vs. 18.9%; aHR 8.89) compared to transcatheter aortic valve replacement in low-risk aortic stenosis patients.
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