TAVR and surgery demonstrated comparable and sustained valve durability in low-risk patients with symptomatic severe aortic stenosis (AS), with both approaches showing low and similar rates of structural valve deterioration (SVD), all-cause bioprosthetic valve failure (BVF) and reintervention through seven years, according to results from an ad hoc analysis of the PARTNER 3 trial published June 24 in JAMA Cardiology.

For this analysis, Julien Ternacle, MD, PhD, et al., for the PARTNER 3 Investigators included all patients who underwent valve implantation (495 with TAVR with the balloon-expandable SAPIEN 3 valve and 453 with surgery). Seven-year follow-up using the Valve Academic Research Consortium 3 criteria occurred in March 2025. The trial ran from March 2016 to October 2017 at 71 centers in the U.S. and Canada.

The primary outcomes were stage 2 or 3 bioprosthetic valve dysfunction (BVD) related to SVD, thrombosis or endocarditis; all-cause BVF related to SVD; and aortic valve reintervention at seven years. Researchers analyzed cumulative incidence rates with death as a competing risk.

Of included patients (mean age of 74 years, 69% men), 537 patients (80%) were still alive, enrolled in the study at seven-year follow-up and available for echocardiographic analysis.

Results showed that the cumulative incidence rates with TAVR and surgery, respectively, were: 7% vs. 8% for stage 2 or 3 SVD-related BVD; 7% vs. 8% for all-cause BVF; 4% vs. 5.3% for SVD-related BVF; and 6% in both groups for valve reintervention.

Additionally, stage 2 or 3 thrombosis-related BVD (subclinical and clinical) occurred more frequently in the TAVR that the surgery group (5% vs. 1%) although most events occurred within three years and few progressed to BVF. Rates of stage 2 or 3 endocarditis-related BVD were low and comparable between groups (0.4% with TAVR vs. 0.5% with surgery). Similarly, the proportion of patients who were alive and free from all-cause BVF did not differ significantly (73% with TAVR vs. 75% with surgery).

"...[Seven]-year durability outcomes from PARTNER 3 support SAPIEN 3 TAVR as a strong option for the initial valve intervention when considering lifetime management," write the authors. "Interpretation of long-term outcomes must therefore consider contemporary practices at trial onset."

"For now, the PARTNER 3 trial durability analysis offers reassuring evidence of excellent midterm outcomes in low-risk patients," write Patrizio Lancellotti, MD, FACC; Yun Yun Go, MBBS; and Mani A. Vannan, MBBS, FACC, in an accompanying editorial. "As TAVR continues to move into younger populations, understanding which durability pathways matter, and in whom, will be key to building effective lifetime valve strategies in the management of AS."