Perspective:

These relatively long-term follow-up data from a multicenter, randomized trial of TAVR vs. SAVR in patients ≥70 years of age with severe symptomatic aortic stenosis at low operative risk suggest similar clinical outcomes in terms of all-cause mortality, stroke, or MI; superior hemodynamics and lower risk of SVD after TAVR; and similar risk between groups of bioprosthetic valve failure. Although reassuring for the use of TAVR in low-risk patients, the study is limited by two factors. First, longer-term outcomes among a study cohort with an average age of 79 years at the time of intervention might not be applicable to younger patients who have fewer competing morbidity and mortality risks. Second, the devices used might not be representative of those commonly used today. Understandably, TAVR utilized a first-generation device, which might not be representative of devices currently implanted. Of greater concern, the surgically implanted bioprostheses predominantly (90%) included devices with either known poor hemodynamic profiles or known issues with durability, biasing the surgical comparison group toward anticipated less favorable hemodynamics and higher rates of SVD.