TAVR linked to stronger valve performance than SAVR in new 5-year study
Performing transcatheter aortic valve replacement (TAVR) on intermediate- and high-risk patients with severe aortic stenosis is associated with a significantly lower five-year risk of bioprosthetic valve dysfunction (BVD) when compared to surgical aortic valve replacement (SAVR), according to new data presented at the Cardiovascular Research Technologies (CRT) 2025 conference in Washington, D.C.
The analysis, published in the Journal of the American College of Cardiology, included pooled data from more than 5,000 patients.
“TAVR has been established as an alternative to surgery in patients with symptomatic severe aortic stenosis irrespective of surgical risk,” wrote first author Steven J. Yakubov, MD, an interventional cardiologist with Ohio Health, and colleagues. “Lifetime management after aortic valve replacement is an important part of decision making, particularly in younger, low-risk patients. Long-term valve performance is a critical consideration when evaluating bioprosthesis durability to avoid persistent or recurrent symptoms or the need for reintervention.”
Yakubov et al. tracked data from 5,606 patients who were treated with either TAVR or SAVR. Approximately 41 percent of patients came from a previous randomized controlled trial (RCT), and the remaining non-RCT patients came from the CoreValve Extreme Risk Pivotal trial or the CoreValve Continued Access Study.
The mean patient age was 82.2 years old, and 45.2% of patients were women. All TAVR patients received a CoreValve/Evolut valve from Medtronic.
BVD was defined as either stage ≥ 2 hemodynamic structural valve deterioration, non-structural valve dysfunction, clinical valve thrombosis associated with clinical sequelae and hemodynamic impairment or infectious endocarditis of the native valve or bioprosthesis. Echocardiograms were used to identify signs of BVD, and each potential incident was confirmed by an expert review.
Overall, researchers found that BVD was seen in 9.7% of RCT patients who underwent TAVR and 15.3% of RCT patients who underwent SAVR.
In addition, the group aimed to gain a better understanding of how BVD impacts a patient’s risk of experiencing a poor clinical outcome. In a pooled cohort combining RCT and non-RCT patients, they confirmed that BVD was directly associated with an increased risk of all-cause mortality, cardiovascular mortality or hospitalization for valve disease/worsening heart failure after five years.
“This is the first analysis to validate clinical criteria for bioprosthetic valve performance and show that the development of BVD in TAVR or surgery patients is associated with at least a 50% relative increase in the five-year hazard of death or hospitalization for valve disease or worsening heart failure,” the authors wrote. “Although long-term 10-year follow-up is ongoing, the correlation of valve performance with five-year clinical outcomes should be a key consideration in selecting the first bioprosthetic valve in patients with symptomatic severe AS undergoing aortic valve replacement.”
Medtronic funded this study as well as much of the other research used to reach these conclusions. Medtronic also funded the SMART trial, another analysis focused on the long-term risks of BVD following TAVR. A two-year update on the SMART trial was presented as part of CRT 2025.
Click here to read the full analysis.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.