Five-Year Outcomes Similar for Intermediate Risk Patients Receiving Transcatheter, Surgical Aortic Valve Replacement

There was no difference in all-cause mortality or stroke between patients with aortic stenosis at intermediate surgical risk who had transcatheter aortic valve replacement (TAVR) or surgery, according to 5-year data from the SURTAVI trial. Though there was initially a higher number of reinterventions following TAVR, the rates became similar after 2 years, and clinical endpoints were also similar between the 2 methods. These findings were presented at TCT 2021, an annual scientific symposium of the Cardiovascular Research Foundation.

“Longer-term outcomes data from the SURTAVI randomized trial comparing early-generation TAVR to open-heart surgery are similar and encouraging for TAVR in younger, healthier patients with aortic stenosis,” said Nicolas M. Van Mieghem, MD, PhD, professor of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, in a press release.

The study followed 1660 intermediate-risk patients who underwent attempted implant of a transcatheter aortic valve (n=864) or a surgical valve (n=796) at 87 centers in Canada, Europe, and the United States. Patients were stratified by investigational site and need for revascularization.

According to the study results, the composite rate of death or disabling stroke at 5 years was similar in both groups at 31.3% for TAVR and 30.8% for surgery. At 2 years, reinterventions were higher with TAVR at 2.5% versus 0.5% for the surgical group. However, by year 5, the reintervention rate for TAVR was 1.0% compared to 1.3% among patients who received surgery.

Core lab-assessed valve regurgitation demonstrated that surgery patients had significantly less ≥ mild aortic regurgitation or paravalvular leak than TAVR at 1-, 2-, and 5-year follow-ups. Although Kansas City Cardiomyopathy Questionnaire summary scores were higher for TAVR patients at 1 year, scores were similar at each additional follow up through 5 years. Further, forward-flow hemodynamics were significantly better with TAVR.

The investigators said that early randomized TAVR trials had enrolled patients at high operative risk with reserved long-term prognoses, and limited long-term data exist comparing surgery with self-expanding supra-annular TAVR.

REFERENCE

Intermediate-risk patients have similar five-year outcomes with transcatheter or surgical aortic valve replacement [news release]. EurekAlert; November 8, 2021. Accessed November 10, 2021. https://www.eurekalert.org/news-releases/934101