Objective analysis of frailty-based 10-year outcomes of transcatheter and surgical aortic valve replacement

Yoshitaka Naito; Arudo Hiraoka; Manami Himeno; Toshinobu Yoshida; Satoru Kishimoto; Genta Chikazawa; Yoshihito Okumura; Hidenori Yoshitaka

doi:10.1016/j.xjse.2025.100065

July 31, 2025JTCVS structural and endovascular.Open Access

Objective analysis of frailty-based 10-year outcomes of transcatheter and surgical aortic valve replacement

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Why the study?

To compare long-term outcomes of TAVI versus SAVR in aortic stenosis by adjusting for conventional risk scores, frailty, cognitive function, nutritional status, and comorbidities.

Does isolated surgical aortic valve replacement (SAVR) improve long-term survival and reduce cardiac readmissions compared to transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis after adjusting for frailty, cognitive function, and nutritional status?

Structured PICO

Does isolated surgical aortic valve replacement (SAVR) improve long-term survival and reduce cardiac readmissions compared to transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis after adjusting for frailty, cognitive function, and nutritional status?

P

Population

1,258 patients with aortic stenosis undergoing isolated elective aortic valve replacement (SAVR n=446; TAVI n=812), with 114 propensity score-matched pairs (n=228) based on 19 baseline variables including frailty, cognitive function, and nutritional status. Overall mean age 81 ± 8 years, 63% female (matched cohort: mean age 81 ± 4 years, 60%-61% female, mean STS score 11 ± 7), treated at a single institution in Japan (Sakakibara Heart Institute of Okayama). Exclusions: emergency and quasi-emergency cases, combined major vascular and coronary surgeries.

I

Intervention

Isolated elective surgical aortic valve replacement (SAVR)

C

Comparator

Isolated elective transcatheter aortic valve implantation (TAVI) (approximately 70% balloon-expandable valves); propensity score-matched (1:1) on 19 baseline characteristics including age, sex, comorbidities, echocardiographic parameters, STS score, Clinical Frailty Scale, Mini-Mental State Examination, and Geriatric Nutritional Risk Index.

O

Outcome

Composite of all-cause mortality and cardiac readmission owing to heart failure or arrhythmia over a follow-up period of up to 10 years.composite

Limitations

Retrospective, non-randomized single-center analysis with potential residual selection bias and unmeasured confounding factors.
Differences in procedures and devices used (approximately 70% balloon-expandable valves in the TAVI group) may have influenced treatment outcomes.
Study population in Japan had relatively high STS scores compared to recent studies, reflecting a rapidly aging population.
Changes in TAVI indications, operator learning curve, and device development over the 10-year study period may hinder result evaluation.

Implication

After propensity score matching for frailty, cognitive function, and nutritional status alongside conventional risk scores, isolated SAVR was associated with superior 10-year survival and comparable cardiac readmission rates compared to TAVI.

Abstract

Objective To compare the long-term outcomes of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS) by adjusting not only for conventional risk scores but also for frailty, cognitive function, nutritional status, and comorbidities. Methods This retrospective single-center study included 1258 patients (SAVR, n=446; TAVI, n=812) who underwent isolated elective procedures for AS between January 2014 and December 2024. Propensity score matching (1:1) was performed based on 19 baseline variables including age, Society of Thoracic Surgeons risk score, Clinical Frailty Scale, Mini-Mental State Examination, and Geriatric Nutritional Risk Index. The primary endpoint was a composite of all-cause mortality and cardiac readmission over a follow-up period of up to 10 years. Results After matching, 114 patient pairs were obtained. The SAVR group had longer intensive care unit and hospital stays. However, there were no significant differences in 30-day mortality, stroke, pacemaker implantation, or readmission rates. Over long-term follow-up, a significantly better survival rate was seen in the SVAR group compared to the TAVI group (hazard ratio [HR], 0.16; 95% confidence interval [CI], 0.49-0.58; P = .005), while the readmission rate was similar in the 2 groups (HR, 1.0; 95% CI, 0.40-1.69; P = .93). Conclusions After comprehensive adjustment for frailty, cognitive function, and nutritional status, SAVR demonstrated superior long-term survival compared to TAVI, with comparable readmission rates. Personalized treatment strategies for AS should incorporate broader patient-specific factors to guide optimal therapeutic decision making.

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Cite This Study

Naito et al. (2025) studied this question.

synapsesocial.com/papers/6a7095cee36a167817e2635c https://doi.org/10.1016/j.xjse.2025.100065

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Objective analysis of frailty-based 10-year outcomes of transcatheter and surgical aortic valve replacement

Figures

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Objective analysis of frailty-based 10-year outcomes of transcatheter and surgical aortic valve replacement

Figures

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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