TAVI is associated with a substantial and durable survival advantage compared to conservative management in patients with severe aortic stenosis.
Cohort (n=373)
No
Does transcatheter aortic valve implantation (TAVI) improve long-term survival compared to conservative management in patients with severe aortic stenosis discussed at a multidisciplinary team meeting?
In patients with severe aortic stenosis, TAVI confers a substantial and durable 5-year survival advantage over conservative management, highlighting the poor prognosis of untreated severe AS.
Effect estimate: HR 0.38 (95% CI 0.28 to 0.50)
Absolute Event Rate: 44.9% vs 12.1%
p-value: p=<0.001
Objective Multidisciplinary team (MDT) meetings are central to treatment decisions in aortic stenosis (AS), particularly for borderline or high-risk patients. This study evaluates long-term, real-world outcomes according to MDT-selected management strategy within routine clinical practice in this clinically important patient group. Methods We conducted a retrospective cohort study of all patients with severe AS discussed at a transcatheter aortic valve implantation (TAVI) MDT at a tertiary UK centre between January 2014 and December 2016. Patients were categorised as TAVI or non-TAVI (conservatively managed). Demographic, clinical and frailty data were collected, including Charlson Comorbidity Index, Clinical Frailty Scale (CFS) and number of prescribed medications. Survival was analysed using Kaplan-Meier estimates and Cox proportional hazards modelling adjusted for age, sex, frailty, comorbidity burden and medication count. Results A total of 373 patients were included (TAVI=178; non-TAVI=195). Patients undergoing TAVI were younger (81.3 years vs 83.5 years; p=0.01) and less frail (CFS 3.9 vs 4.9; p<0.01). Survival at 1 year, 2 years and 5 years was significantly higher following TAVI (87.6%, 74.7%, 44.9%) compared with conservative management (60.8%, 44.2%, 12.1%; p<0.001). Median survival was 53 months after TAVI versus 20 months without intervention. On multivariable analysis, TAVI was independently associated with reduced mortality (HR 0.38, 95% CI 0.28 to 0.50; p<0.001). Conclusions In patients with severe AS discussed at MDT, TAVI was associated with a substantial and durable survival advantage compared with conservative management. These findings highlight the poor prognosis of untreated severe AS and support systematic inclusion of conservatively managed patients in interventional registries to better inform MDT deliberation and shared decision-making.
Manning et al. (2026) conducted a cohort in severe aortic stenosis (n=373). Transcatheter aortic valve implantation (TAVI) vs. Conservative management was evaluated on All-cause survival (HR 0.38, 95% CI 0.28 to 0.50, p=<0.001). TAVI is associated with a substantial and durable survival advantage compared to conservative management in patients with severe aortic stenosis.