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2-Year Outcomes for Surgery vs. TAVR
Study Questions:
What are the 2-year outcomes in patients undergoing surgical or self-expanding transcatheter aortic valve replacement (TAVR)?
Methods:
The investigators recruited patients with severe aortic stenosis who were at increased surgical risk. Eligible patients were randomly assigned in a 1:1 ratio to TAVR with the self-expanding transcatheter valve (TAVR group) or to aortic valve replacement with a surgical bioprosthesis (surgical group). The authors evaluated the 2-year clinical and echocardiographic outcomes in these patients.
Results:
A total of 797 patients underwent randomization at 45 centers in the United States. The rate of 2-year all-cause mortality was significantly lower in the TAVR group (22.2%) than in the surgical group (28.6%; log rank p < 0.05) in the as-treated cohort, with an absolute reduction in risk of 6.5 percentage points. Similar results were found in the intention-to-treat cohort (log rank p < 0.05). The rate of 2-year death or major stroke was significantly lower in the TAVR group (24.2%) than in the surgical group (32.5%; log rank p = 0.01).
Conclusions:
The authors concluded that in patients with severe aortic stenosis at increased surgical risk, the higher rate of survival with a self-expanding TAVR compared with surgery was sustained at 2 years.
Perspective:
This study reports that TAVR was associated with improved survival at 2 years compared with surgery in patients at increased risk for surgery. Furthermore, a sustained improvement in aortic-valve hemodynamics without structural valve deterioration was associated with the self-expanding transcatheter bioprostheses. While this randomized study suggests that self-expanding transcatheter valve therapy may be preferred over surgery in this patient population, additional prospective studies are needed to validate these findings.
Keywords: Aortic Valve, Aortic Valve Stenosis, Bioprosthesis, Cardiac Surgical Procedures, Echocardiography, Heart Valve Diseases, Heart Valve Prosthesis, Hemodynamics, Intention to Treat Analysis, Stroke, Transcatheter Aortic Valve Replacement
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