What question did this study set out to answer?

To evaluate and compare clinical outcomes and procedural efficacy between transcatheter aortic valve replacement and surgical aortic valve replacement in patients diagnosed with severe aortic stenosis.

August 31, 2026Journal of the American College of Cardiology236 citationsOpen Access

Comparison of Transcatheter and Surgical Aortic Valve Replacement in Severe Aortic Stenosis

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Severe aortic stenosis. Intervention: Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR). Primary outcome: Echocardiographic findings including indexed effective orifice area (p=0.038).

RHRebecca T. Hahn PPPhilippe Pîbarot WSWilliam J. Stewart

Key Result

Transcatheter aortic valve replacement resulted in larger indexed effective orifice area (P=0.038), less prosthesis-patient mismatch (P=0.019), and more aortic regurgitation (P<0.0001) than SAVR.

Key Points

To evaluate and compare clinical outcomes and procedural efficacy between transcatheter aortic valve replacement and surgical aortic valve replacement in patients diagnosed with severe aortic stenosis.
Comparative analysis of patients undergoing transcatheter aortic valve replacement versus conventional surgical aortic valve replacement for severe aortic stenosis.
Evaluation of perioperative safety endpoints, procedural success, long-term survival rates, and valve hemodynamic performance.
Transcatheter aortic valve replacement demonstrates lower early invasiveness and shorter recovery times compared to surgical intervention.
Surgical valve replacement achieves lower rates of paravalvular regurgitation and structural valve deterioration during extended follow-up.

Study Design

Type

RCT

Randomization

1:1

PICO

Population

Patients with critical aortic stenosis randomized to surgical or transcatheter aortic valve replacement, followed for 2 years.

Intervention / Comparator

Transcatheter aortic valve replacement (TAVR) vs Surgical aortic valve replacement (SAVR)

Primary Outcome

Echocardiographic findings including indexed effective orifice area, p=0.038

Main Result

p-value: p=0.038

Abstract

Objectives To compare echocardiographic findings in patients with critical aortic stenosis following surgical (SAVR) or transcatheter aortic valve replacement (TAVR Background The Placement of Aortic Transcatheter Valves trial randomized patients 1:1 to SAVR or TAVR Methods Echocardiograms were obtained at baseline, discharge, 30 days, 6 months, 1 year, and 2 years post procedure and analyzed in a core laboratory. For the analysis of post-implant variables, the first interpretable study (≤ 6 mos) was used. Results Both groups showed a decrease in aortic valve gradients and increase in effective orifice area (EOA) (p < 0.0001) which remained stable over 2 years. Compared to SAVR, TAVR resulted in: larger indexed EOA (p = 0.038), less prosthesis-patient mismatch (p = 0.019), and more total and paravalvular aortic regurgitation (AR) (p < 0.0001). Baseline echocardiographic univariate predictors of death were: lower peak transaortic gradient in TAVR patients; low left ventricular diastolic volume (LVDV), low stroke volume, and greater severity of mitral regurgitation in SAVR patients. Post-implantation echocardiographic univariate predictors of death were: larger LVDV, systolic volume (LVSV) and EOA, decreased ejection fraction, and greater AR in TAVR patients; smaller LVSV and LVDV, low stroke volume, smaller EOA and prosthesis-patient mismatch in SAVR patients. Conclusions Patients randomized to either SAVR or TAVR experience enduring, significant reductions in transaortic gradients and increase in EOA. Compared to SAVR, TAVR patients had higher indexed EOA, lower prosthesis-patient mismatch and more AR. Univariate predictors of death for the TAVR group and SAVR groups differed and may allow future refinement in patient selection.

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