Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are associated with comparable adverse outcome rates after 10 years, according to new data published in European Heart Journal.[1] There were, however, certain differences between the two treatment options that cardiologists should remember when recommending treatment for patients with severe aortic stenosis (AS).
“The general recommendation for the use of surgical bioprosthetic aortic valves as opposed to mechanical valves is age older than 65 years, but as TAVR offers a less invasive treatment, an increasing number of younger patients are now treated with transcatheter heart valves (THVs),” wrote first author Hans Gustav Hørsted Thyregod, MD, PhD, with Copenhagen University Hospital in Denmark, and colleagues. “In the United States, about half of the patients younger than 65 years treated for isolated AS undergo TAVR. Due to the longer life expectancy of these patients, evidence on long-term durability of THV vs. surgical bioprostheses is needed.”
Thyregod et al. explored 10-year data from the NOTION trial, which they say was the first time a clinical trial including low-risk patients was randomized to either undergo TAVR or SAVR. All patients underwent treatment from 2009 to 2013. A total of 280 patients were included in this analysis; 145 underwent TAVR with a self-expanding CoreValve device from Medtronic and the other 135 underwent SAVR with a bioprosthesis.
Mean ages (approximately 79 years old) and mean Society of Thoracic Surgeons scores were comparable between the two groups. Overall, the study’s primary outcome—a composite of all-cause mortality, stroke or myocardial infarction after 10 years—was seen in the exact same percentage of TAVR and SAVR patients: 65.5%.
Severe structural valve deterioration (SVD), meanwhile, was seen in 1.5% of TAVR patients and 10% of SAVR patients after 10 years. Non-structural valve dysfunction (NSVD) was also much less common after TAVR (20.5% of patients) than after SAVR (43% of patients).
There were other key differences between the two treatment options after 10 years. For example, 44.7% of TAVR patients ultimately required a permanent pacemaker (PPM). This was much higher than the PPM rate of 14% seen among SAVR patients. A majority of PPMs were required within the first year after treatment. Another difference was the fact that mild or greater levels of paravalvular leak (PVL) were seen in 18% of TAVR patients compared to 5.2% of SAVR patients.
The rates of bioprosthetic valve failure and endocarditis, on the other hand, were similar between these two groups after 10 years.
“More long-term follow-up data from trials are required to recommend one type of intervention over the other in lower-risk AS patients,” the authors concluded.
Click here to read the full study in European Heart Journal, a European Society of Cardiology publication.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.