Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyMay 2025
A randomised study demonstrated similar rates of death and stroke with the two interventions.
Transcatheter aortic valve replacement (TAVR) has become the leading treatment for patients with severe, symptomatic aortic stenosis (AS). However, there are limited longterm data on how this procedure compares with surgery, particularly in patients at low risk for surgical AVR.
In this manufacturer-funded, randomised trial, 1414 patients underwent TAVR with a self-expanding supraannular valve or surgery (NCT02701283). Inclusion criteria included a low predicted risk of death (less than 3%; mean, 1.9%); the mean age of patients was 74 years. About 90% of participants were available for five-year follow up.
The primary endpoint of death or disabling stroke was similar with TAVR (15.5%) and surgery (16.4%). Pacemaker implants and mild paravalvular leaks were more frequent with TAVR, while atrial fibrillation was more common after surgery. Quality-of-life scores improved to a similar extent with both treatments.
Aortic valve reintervention was low in both groups (about 3%) with no difference in surgical reintervention mortality.
Comment: For these low-risk patients, TAVR provided a safe and effective alternative to surgery. However, the results should not be automatically extended to much younger patients. In addition, the 10-year planned follow up will be essential to determine whether the good midterm durability of TAVR can be maintained.
Howard C. Herrmann, MD, John W. Bryfogle Professor of Medicine and Surgery, Perelman School of Medicine; Health System Director, Interventional Cardiology, and Director, Cardiac Catheterization Laboratories, Hospital of the University of Pennsylvania, Philadelphia, USA.
Forrest JK, et al. 5-year outcomes after transcatheter or surgical aortic valve replacement in low-risk patients with aortic stenosis. J Am Coll Cardiol 2025 Mar 30; e-pub (https://www.jacc.org/doi/10.1016/j.jacc.2025.03.004).
This summary is taken from the following Journal Watch titles: Cardiology, Ambulatory Medicine, General Medicine.