Study: Transcatheter aortic valve replacement offers similar outcomes to surgical aortic valve replacement

Editor's Note

The largest scale analysis so far available comparing surgical aortic valve replacement (SAVR) to longer-term percutaneous devices for transcatheter aortic valve replacement (TAVR) supports the comparable long-term safety and efficacy of the latter procedure. According to a May 15 report in Medical Xpress, the findings raise important considerations for valve selection, particularly for long-term valve durability and implantation of pacemakers.

Published May 15 in the Journal of the Society for Cardiovascular Angiography & Interventions, the meta-analysis of seven randomized trials compared the outcomes of 7,785 patients undergoing TAVR (a procedure that delivers a new aortic valve into the heart through a catheter) to those undergoing SAVR for severe aortic stenosis. The study found no significant difference in death or disabling stroke between TAVR and SAVR patients (HR 1.02, 95% CI 0.93–1.11, p=0.70) with similar long-term mortality risks.

The results were consistent across different surgical risk profiles (low, intermediate, and high), Medical Xpress reports. TAVR also was associated with an increased likelihood of needing a pacemaker and moderate-to-severe paravalvular leaks. The study also highlighted the differences between two percutaneous TAVR devices, with self-expanding TAVR prostheses demonstrating lower death or stroke risk (P=0.06), valve thrombosis (P= 0.06), and valve gradients (P<0.01), but higher pacemaker implantation rates (P < 0.01) than balloon-expandable TAVR.