3-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis.
Publication/Presentation Date
5-2-2023
Abstract
BACKGROUND: Randomized data comparing outcomes of transcatheter aortic valve replacement (TAVR) with surgery in low-surgical risk patients at time points beyond 2 years is limited. This presents an unknown for physicians striving to educate patients as part of a shared decision-making process.
OBJECTIVES: The authors evaluated 3-year clinical and echocardiographic outcomes from the Evolut Low Risk trial.
METHODS: Low-risk patients were randomized to TAVR with a self-expanding, supra-annular valve or surgery. The primary endpoint of all-cause mortality or disabling stroke and several secondary endpoints were assessed at 3 years.
RESULTS: There were 1,414 attempted implantations (730 TAVR; 684 surgery). Patients had a mean age of 74 years and 35% were women. At 3 years, the primary endpoint occurred in 7.4% of TAVR patients and 10.4% of surgery patients (HR: 0.70; 95% CI: 0.49-1.00; P = 0.051). The difference between treatment arms for all-cause mortality or disabling stroke remained broadly consistent over time: -1.8% at year 1; -2.0% at year 2; and -2.9% at year 3. The incidence of mild paravalvular regurgitation (20.3% TAVR vs 2.5% surgery) and pacemaker placement (23.2% TAVR vs 9.1% surgery; P < 0.001) were lower in the surgery group. Rates of moderate or greater paravalvular regurgitation for both groups were
CONCLUSIONS: Within the Evolut Low Risk study, TAVR at 3 years showed durable benefits compared with surgery with respect to all-cause mortality or disabling stroke. (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients; NCT02701283).
Volume
81
Issue
17
First Page
1663
Last Page
1674
ISSN
1558-3597
Published In/Presented At
Forrest, J. K., Deeb, G. M., Yakubov, S. J., Gada, H., Mumtaz, M. A., Ramlawi, B., Bajwa, T., Teirstein, P. S., DeFrain, M., Muppala, M., Rutkin, B. J., Chawla, A., Jenson, B., Chetcuti, S. J., Stoler, R. C., Poulin, M. F., Khabbaz, K., Levack, M., Goel, K., Tchétché, D., … Low Risk Trial Investigators (2023). 3-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis. Journal of the American College of Cardiology, 81(17), 1663–1674. https://doi.org/10.1016/j.jacc.2023.02.017
Disciplines
Medicine and Health Sciences
PubMedID
36882136
Department(s)
Department of Medicine
Document Type
Article