TAVR and SAVR linked to comparable long-term outcomes, new meta-analysis confirms
Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are associated with comparable long-term outcomes among low-risk patients with severe aortic stenosis (AS), according to a new meta-analysis published in The American Journal of Cardiology.[1]
TAVR has cemented its place as the go-to treatment option for many AS patients, the authors noted, and more and more studies have confirmed it is equal to SAVR. Hoping to learn more about its impact over extended follow-up periods, the group combined data from three well-known clinical trials—NOTION, Evolut Low Risk and PARTNER 3—and compared more than 1,3000 TAVR patients with more than 1,200 SAVR patients. The average age was 75.5 years old, 62.9% were men and the mean Society of Thoracic Surgeons score was 2.2. The mean follow-up period was six years.
TAVR valves implanted in these trials were manufactured by either Medtronic of Edwards Lifesciences.
Overall, the group confirmed that TAVR was non-inferior to SAVR when it came to all-cause death, cardiovascular death, myocardial infarction, aortic valve reintervention, endocarditis and bioprosthetic valve failure.”
Two key differences between the treatment strategies did crystalize: TAVR was linked to a heightened risk of permanent pacemaker implantation, and SAVR was linked to more cases of new-onset atrial fibrillation.
The group also noted that they identified no signs of bias when reviewing the three clinical trials.
“Based on the results of the present meta-analysis seems reasonable to expand the indication of TAVR to ‘selected’ (e.g. tricuspid aortic valves with transfemoral route suitable for TAVR) younger, lower-risk patients,” wrote corresponding author Alfonso Ielasi, MD, a cardiologist with Ospedale Galeazzi-Sant'Ambrogio in Italy, and colleagues. “However, the choice between the two treatment options should still be made based on a shared decision-making process after careful consideration on the patient's life expectancy and bioprosthesis durability. A meticulous evaluation of the patient's personal preference, anatomical and procedural factors, weighing the risks and benefits of each approach for the individual patient is strongly advised.”
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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.