Key result
TAVR is linked to a ~34% lower 5-year risk of composite aortic dissection versus SAVR.
Why the study?
The risk of aortic dissection with transcatheter aortic valve replacement compared with surgical aortic valve replacement remains unclear.
Does transcatheter aortic valve replacement reduce the risk of aortic dissection compared to surgical aortic valve replacement in patients with aortic valve disease?
Cohort (n=40,474)
Yes
Does transcatheter aortic valve replacement reduce the risk of aortic dissection compared to surgical aortic valve replacement in patients with aortic valve disease?
Hazard Ratio: 0.66 (95% CI 0.51–0.86)
Absolute Event Rate: 0.47% vs 0.71%
p-value: p=0.002
TAVR was associated with lower aortic dissection risk than SAVR in matched patients; leaves open whether this alters procedural selection or requires randomized confirmation.
Background:Aortic valve replacement is the primary treatment for aortic valve disease and can be performed using either transcatheter (TAVR) or surgical (SAVR) approaches. The risk of aortic dissection (AD) with TAVR compared with SAVR remains unclear. We aimed to compare AD risk between TAVR and SAVR using a large, real-world cohort. Methods:We conducted a retrospective cohort analysis using the TriNetX research network. Patients with a diagnosis of aortic stenosis, aortic insufficiency, mixed aortic valve disease (AVD), or unspecified AVDwho underwent either TAVR or SAVR were included. A 1:1 propensity score-matching (PSM) based on baseline characteristics was performed to adjust for potential confounding. Logistic regression and Cox proportional hazards models were used to estimate odds ratios (ORs) and hazard ratios (HRs), with 95% confidence intervals (CIs).Results:Among 95,043 patients undergoing isolated aortic valve replacement, 20,237 matched pairs were analyzed after 1:1 PSM. Baseline characteristics were well balanced, with a mean age of 73.3 ± 9.3 years in the TAVR group and 73.2 ± 8.5 years in the SAVR group; 60.8% and 60.7% were male, respectively. TAVR was associated with significantly lower odds of composite AD than SAVR at all time points (1-year OR 0.60; 95% CI 0.44–0.82; 3-year OR 0.64; 95% CI 0.48–0.83; 5-year OR 0.66; 95% CI 0.51–0.85; p < 0.01 for all). Stratified analyses demonstrated lower odds of both Stanford type A and type B AD at all time points. Kaplan–Meier analysis demonstrated a separation in composite AD-free survival between the two groups (HR 0.66; 95% CI 0.51–0.86; p = 0.002).Conclusion:In this large, real-world cohort, despite a low event rate, TAVR was associated with a significantly lower likelihood of composite AD than SAVR.
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Doma et al. (2026) conducted a cohort in Aortic valve disease (n=40,474). Transcatheter Aortic Valve Replacement (TAVR) vs. Surgical Aortic Valve Replacement (SAVR) was evaluated on Composite incidence of any aortic dissection over 5 years (HR 0.66, 95% CI 0.51-0.86, p=0.002). Transcatheter aortic valve replacement was associated with a significantly lower hazard of composite aortic dissection compared to surgical aortic valve replacement over 5 years (HR 0.66).
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