Long-term data now support comparable outcomes between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) across low- and intermediate-risk populations, with both approaches demonstrating durable valve performance at mid-term follow-up in low-risk patients.
A 2023 meta-analysis of 12 studies including 37,825 intermediate- to high-risk patients found no significant differences between TAVR and SAVR in all-cause mortality (RR 1.03), 30-day mortality (RR 0.84), new-onset atrial fibrillation, or vascular complications.1 TAVR was associated with a 25% reduction in stroke risk (RR 0.75, 95% CI 0.62 to 0.92) and a 68% reduction in respiratory complications (RR 0.32, 95% CI 0.20 to 0.52), while pacemaker implantation rates were higher with TAVR (RR 2.03, 95% CI 1.54 to 2.67).1
The PARTNER 3 trial randomized 1,000 low-risk patients (mean age 73 years) to TAVR with a balloon-expandable valve or SAVR.2 Early results favored TAVR, with the primary composite endpoint of death, stroke, or rehospitalization occurring in 8.5% of the TAVR arm versus 15.1% of SAVR patients at one year.2 Seven-year follow-up data showed no statistically significant differences between groups: the primary endpoint occurred in 34.6% of TAVR and 37.2% of SAVR patients. All-cause mortality was 19.5% with TAVR and 16.8% with SAVR (non-significant). Bioprosthetic valve failure was 6.9% versus 7.3%, with similar reintervention rates.3
Five-year results from the Evolut Low Risk trial confirmed non-inferiority of TAVR with a supra-annular self-expanding valve. The primary endpoint of all-cause mortality or disabling stroke was 15.5% with TAVR and 16.4% with SAVR (non-significant). Atrial fibrillation remained substantially lower with TAVR (16.3% vs. 41.2%), while permanent pacemaker implantation rates were higher (27% vs. 11.3%), though pacemaker placement did not affect 5-year mortality.4 Both trials have 10-year follow-up planned, which will be particularly informative for the growing population of younger, lower-risk patients.
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