TAVR vs. SAVR: Real-world data highlight advantages of both techniques
Transcatheter aortic valve replacement (TAVR) is associated with better in-hospital outcomes than surgical aortic valve replacement (SAVR), according to a new analysis published in The Annals of Thoracic Surgery.[1] However, researchers noted, SAVR was linked to superior long-term outcomes, including a lower stroke risk, for both low- and intermediate-risk patients.
The newly published study included data from nearly 160,000 patients 65 to 85 years old who underwent aortic valve replacement from 2018 to 2022. All data came from the U.S. Centers for Medicare and Medicaid Services database. While 124,897 patients underwent TAVR, another 34,215 underwent first-time SAVR. The median follow-up period was 2.7 years.
Using Society of Thoracic Surgeons mortality risk scores as their primary guide, researchers determined if each study participant was a low-, intermediate- or high-risk patient. The low-risk group was represented by more than 36,000 TAVR patients and more than 1,400 SAVR patients. The intermediate-risk group, meanwhile, was represented by more than 44,000 TAVR patients and more than 9,000 SAVR patients. The high-risk group was represented by 44,000 TAVR patients and nearly 10,000 SAVR patients.
In all three risk groups, TAVR patients were older and more likely to present with a history of heart failure or coronary artery disease than SAVR patients.
TAVR linked to superior in-hospital outcomes, but a higher pacemaker risk
When focused on in-hospital outcomes, TAVR was consistently linked to lower rates of mortality, acute kidney injury and bleeding events. A transcatheter approach was also associated with a reduced stroke risk for intermediate- and high-risk patients.
SAVR, on the other hand, resulted in a lower risk of requiring a permanent pacemaker for all three risk groups.
SAVR linked to superior longitudinal outcomes for low-, intermediate-risk patients
At the end of the five-year study, SAVR was associated with a higher rate of freedom from the composite primary outcome of death, stroke or valve reintervention than TAVR for both low- and intermediate-risk patients. SAVR was also associated with superior freedom from stroke independent of death or valve reintervention.
Among high-risk patients, SAVR lost its significant advantage over TAVR, but the two treatment methods were still statistically similar.
Lessons learned
TAVR and SAVR have certainly been compared to one another in the past. What were the biggest takeaways from this latest analysis?
“TAVR was associated with superior in-hospital outcomes among Medicare beneficiaries across all risk strata but worse longitudinal freedom from death, stroke, or valve reintervention compared to SAVR in the low- and intermediate-risk populations,” wrote first author Stanley Wolfe, MD, a cardiothoracic surgery follow with West Virginia Heart and Vascular Institute, and colleagues. “Furthermore, TAVR was associated with significantly higher incidence of risk-adjusted stroke over the five-year study period compared to SAVR in low and intermediate risk cohorts. These contemporary, real-world data may provide additional guidance for multidisciplinary heart teams to weigh individual patient risks with the benefits of TAVR vs SAVR on longitudinal outcomes.”
Click here to read the full study.
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.