TAVR Compared With SAVR in Low-Risk Patients

May 16, 2016—Stefano Rosato, MSc, et al published findings from an analysis that sought to describe outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in low-risk patients. The study is available online ahead of print in Circulation: Cardiovascular Interventions.

The background of the study is that the proven efficacy of TAVR in high-risk patients is leading to the expansion of its indications toward lower-risk patients. However, this shift is not supported by meaningful evidence of its benefit over SAVR.

As summarized in Circulation: Cardiovascular Interventions, the investigators compared the outcome after TAVR and SAVR of low-risk patients (EuroSCORE II < 4%) included in the Observational Study of Effectiveness of SAVR–TAVR Procedures for Severe Aortic Stenosis Treatment (OBSERVANT) study. 

The OBSERVANT research group reported that the primary outcome was 3-year survival. Secondary outcomes were early events and major adverse cardiac and cerebrovascular events at 3 years. Propensity score matching resulted in 355 pairs of patients with similar baseline characteristics. Thirty-day survival was 97.1% after SAVR and 97.4% after TAVR (P = .82).

Cardiac tamponade, permanent pacemaker implantation, major vascular damage, and moderate-to-severe paravalvular regurgitation were significantly more frequent after TAVR compared with SAVR. Stroke rates were equal in the study groups. SAVR was associated with a higher risk of cardiogenic shock, severe bleeding, and acute kidney injury. At 3 years, survival was 83.4% after SAVR and 72% after TAVR (P = .0015), whereas freedom from major adverse cardiac and cerebrovascular events was 80.9% after SAVR and 67.3% after TAVR (P < .001).

The OBSERVANT investigators concluded that in patients with low operative risk, significantly better 3-year survival and freedom from major adverse cardiac and cerebrovascular events were observed after SAVR compared with TAVR. Further studies on new-generation valve prostheses are necessary before expanding indications of TAVR toward lower-risk patients, advised the investigators in Circulation: Cardiovascular Interventions.