SAVR linked to higher 10-year survival rate than TAVR for low-risk patients
Surgical aortic valve replacement (SAVR) is associated with a much higher long-term survival rate than transcatheter aortic valve replacement (TAVR) when treating low-risk patients, according to new 10-year data published in IJC Heart & Vasculature.[1]
“TAVR has transformed the treatment of severe aortic stenosis (AS) by providing a safe and effective alternative, particularly for elderly patients,” wrote first author Fausto Biancari, MD, PhD, a cardiac surgeon with Centro Cardiologico Monzino in Milan, Italy, and colleagues. “However, the evidence of the long-term advantages of TAVR over SAVR remain scarce.”
For the OBSERVANT study, Biancari et al. explored data from 355 matched pairs of patients who underwent TAVR or SAVR from December 2010 to June 2012. All TAVR patients received early-generation transcatheter heart valves from Medtronic or Edwards Lifesciences. Each patient’s EuroSCORE II was calculated to determine their risk. Only those with a EuroSCORE II less than 4% were included.
The two groups were matched to have similar patient characteristics. For example, the mean patient age was approximately 80 years old and nearly 60% of patients were male in each group. Coronary artery disease and peripheral arteriopathy were still slightly more common among TAVR patients, however, and pulmonary disease was slightly more common among SAVR patients.
All-cause mortality after 30 days was 2.8% for SAVR and 2.5% for TAVR. However, the difference between these two treatment options started to become significant after approximately three years. By the time 10 years had passed, 37% of SAVR patients and 18.2% of TAVR patients were still alive. Repeat aortic valve procedures, meanwhile, were seen in 2.6% of SAVR patients and 1.1% of TAVR patients.
Because this analysis reflects 10 years of follow-up data, the TAVR devices patients received are quite different than the ones being implanted in low-risk AS patients today. Even so, Biancari et al. believe their findings are still quite relevant to modern patients.
“How can we consider the validity and clinical relevance of the present findings in the context of results from randomized clinical trials and continuous evolution of TAVR technology?” the group asked. “The methodology of randomized clinical trials makes them at the top of hierarchy for the evidence on the safety and efficacy of TAVR compared to SAVR. Still, high-quality observational studies can provide substantial evidence of the consistency of results of randomized clinical trials, particularly in subsets of patient populations with different characteristics. In the setting of all-comers studies, the prospective OBSERVANT study may provide insights, which have been confirmed by other observational studies.”
They then pointed to a retrospective study published in Interdisciplinary Cardiovascular and Thoracic Surgery that ended with a similar conclusion: TAVR and SAVR were associated with similar 30-day mortality rates, but follow-up data showed that SAVR patients were much more likely to survive past five years than those treated with TAVR.[2]
Click here to read the full analysis in IJC Heart & Vasculature.
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.