Transcatheter aortic valve replacement has demonstrated non-inferiority to surgical aortic valve replacement across all strata of surgical risk with respect to survival and key clinical endpoints.
How does TAVR compare to SAVR in the treatment of aortic stenosis across different patient populations?
While TAVR is a first-line treatment for many patients with aortic stenosis, SAVR remains essential for younger patients and those with complex valve anatomies due to uncertainties in long-term TAVR durability.
Aortic stenosis (AS) is the most commonly treated valvulopathy worldwide, affecting more than 9.4 million patients. Surgical aortic valve replacement (SAVR) has long been the standard treatment for severe AS. As a less invasive approach that avoids open-heart surgery, transcatheter aortic valve replacement (TAVR) has rapidly gained popularity and is now a first-line treatment modality for many patients with AS. Multiple large prospective trials have demonstrated the non-inferiority of TAVR compared with SAVR with respect to survival and other key clinical endpoints. However, long-term data on valve durability and function after TAVR remain limited in select populations. This is particularly important for younger TAVR recipients, whose life expectancy may exceed the functional lifespan of the valve. Furthermore, the efficacy and safety of TAVR in certain patient subsets, such as those with bicuspid aortic valves (BAVs) or a small aortic annulus (SAA), remain uncertain. In contrast, SAVR continues to provide excellent outcomes across a broad range of valve anatomies. Additionally, surgical implantation of a mechanical valve or a pulmonary autograft via the Ross procedure remains an excellent option for appropriately selected younger surgical candidates. A surgical approach also allows for adjunct procedures, such as aortic annular enlargement, which can be particularly beneficial in patients with smaller aortic annuli. Overall, the data comparing SAVR and TAVR is extensive and continues to evolve. This manuscript aims to review the key studies and provide an overview of contemporary treatment options for AS.
Patil et al. (Mon,) conducted a review in Aortic Stenosis. Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated. Transcatheter aortic valve replacement has demonstrated non-inferiority to surgical aortic valve replacement across all strata of surgical risk with respect to survival and key clinical endpoints.