Three-year outcomes after transcatheter or surgical aortic valve replacement in low-risk patients with aortic stenosis

Authors

• John K. Forrest, Yale University School of Medicine, New Haven, CT. Electronic address: john.k.forrest@yale.edu.
• G Michael Deeb, University of Michigan Health Systems Ok - University Hospital, Ann Arbor, MI.Follow
• Steven J. Yakubov, OhioHealth Riverside Methodist Hospital, Columbus, OH.
• Hemal Gada, University of Pittsburgh Medical Center, Harrisburg, PA.
• Mubashir A. Mumtaz, University of Pittsburgh Medical Center, Harrisburg, PA.
• Basel Ramlawi, Lankenau Heart Institute, Philadelphia, PA.
• Tanvir Bajwa, Advocate Aurora HealthFollow
• Paul S. Teirstein, Scripps Clinic, La Jolla, CA.
• Michael DeFrain, HealthPark Medical Center, Fort Myers, FL.
• Murali Muppala, HealthPark Medical Center, Fort Myers, FL.
• Bruce J. Rutkin, North Shore University Hospital, Manhasset, NY.
• Atul Chawla, Mercy Medical Center, Iowa Heart, Des Moines, IA.Follow
• Bart Jenson, Mercy Medical Center, Iowa Heart, Des Moines, IA.
• Stanley J. Chetcuti, University of Michigan Health Systems Ok - University Hospital, Ann Arbor, MI.Follow
• Robert C. Stoler, Baylor Heart and Vascular Hospital, Dallas, TX.
• Marie-France Poulin, Beth Israel Deaconess Medical Center, Boston, MA.
• Kamal Khabbaz, Beth Israel Deaconess Medical Center, Boston, MA.
• Melissa Levack, Vanderbilt University Medical Center, Nashville, TN.
• Kashish Goel, Vanderbilt University Medical Center, Nashville, TN.
• Didier Tchétché, Clinique Pasteur, Toulouse, France.
• Ka Yan Lam, Catharina Ziekenhuis, Eindhoven, Netherlands.
• Pim A. Tonino, Catharina Ziekenhuis, Eindhoven, Netherlands.
• Saki Ito, Echocardiography Core Laboratory, Mayo Clinic, Rochester, MN.
• Jae K. Oh, Echocardiography Core Laboratory, Mayo Clinic, Rochester, MN.
• Jian Huang, Medtronic, Mounds View, MN.
• Jeffrey J. Popma, Medtronic, Mounds View, MN.
• Neal Kleiman, Methodist DeBakey Heart and Vascular Center, Houston, TX.
• Michael J. Reardon, Methodist DeBakey Heart and Vascular Center, Houston, TX.

Recommended Citation

Forrest JK, Deeb GM, Yakubov SJ, et al. 3-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis. J Am Coll Cardiol. 2023;81(17):1663-1674. doi:10.1016/j.jacc.2023.02.017

Affiliations

Aurora St Luke's Medical Center

Abstract

Background: Randomized data comparing outcomes of transcatheter aortic valve replacement (TAVR) to 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.

Objective: We 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 1414 attempted implants (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; -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

Conclusions: Within the Evolut Low Risk study, TAVR at 3 years showed durable benefits compared to surgery with respect to all-cause mortality or disabling stroke.

Type

Article

PubMed ID

36882136