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TAVR vs. SAVR
Study Questions:
What is the comparative effectiveness of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in a “real-world” setting?
Methods:
OBSERVANT was an observational, prospective, multicenter cohort study, enrolling aortic stenosis patients undergoing SAVR or TAVR. The propensity score method was applied to select two groups of patients undergoing SAVR and TAVR, respectively, with similar baseline characteristics. All outcomes were adjudicated through a linkage with administrative databases. The primary endpoints of this analysis were death from any cause, and major adverse cardiac and cerebrovascular events (MACCE) at 1 year.
Results:
The unadjusted enrolled population (N = 7,618) comprised 5,707 SAVR patients and 1,911 TAVR patients. The matched population comprised a total of 1,300 patients (650 per group). The propensity score method generated a low- to intermediate-risk population (mean logistic EuroSCORE 1: 10.2 ± 9.2% vs. 9.5 ± 7.1%, SAVR vs. transfemoral TAVR; p = 0.104). At 1 year, the rate of death from any cause was 13.6% in the surgical group and 13.8% in the transcatheter group (hazard ratio [HR], 0.99; 95% confidence interval [CI], 0.72-1.35; p = 0.936). Similarly, there were no significant differences in the rates of MACCE, which were 17.6% in the surgical group and 18.2% in the transcatheter group (HR, 1.03; 95% CI, 0.78-1.36; p = 0.831). The cumulative incidence of cerebrovascular events, and rehospitalization due to cardiac reasons and acute heart failure was similar in both groups at 1 year.
Conclusions:
The authors concluded that SAVR and transfemoral TAVR have comparable mortality, MACCE, and rates of rehospitalization due to cardiac reasons at 1 year.
Perspective:
This propensity-matched observational study reports that transfemoral TAVR is comparable to surgical replacement with respect to 1-year rates of death from any cause, MACCE, and repeat hospitalization due to cardiac reasons. This study provides additional support for the comparative effectiveness of these strategies in a real-world setting, generating results that complement data from randomized controlled trials. Ongoing randomized trials SURTAVI and PARTNER 2 will provide additional insight on comparative effectiveness of these strategies with longer-term follow-up.
Keywords: Aortic Valve Stenosis, Cardiac Surgical Procedures, Heart Failure, Heart Valve Diseases, Heart Valve Prosthesis, Transcatheter Aortic Valve Replacement
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