Better 5-Year Valve Performance With TAVI Than Surgery

TOPLINE:In patients with symptomatic severe aortic stenosis at intermediate or higher surgical risk, CoreValve or Evolut transcatheter aortic valve implantation (TAVI) was associated with a lower 5-year incidence of bioprosthetic valve dysfunction than surgery. Valve dysfunction was also associated with an increased risk for death and hospitalization, regardless of replacement therapy.

METHODOLOGY:Researchers conducted a post hoc analysis to compare the valve performances between patients with symptomatic severe aortic stenosis who underwent CoreValve or Evolut TAVI with Medtronic devices and those who underwent surgery.They formed a cohort of 5606 patients (mean age, 82.2 years; 45.2% women) that included those from randomized controlled trials who underwent CoreValve, Evolut TAVI, or surgery and those from noncontrolled trials who underwent CoreValve or Evolut TAVI.The primary endpoint was the incidence of valve dysfunction through 5 years from the controlled trials, assessed using echocardiograms.Bioprosthetic valve dysfunction was defined as stage ≥ 2 structural valve deterioration, nonstructural valve dysfunction, clinical valve thrombosis, or infectious endocarditis.TAKEAWAY:The cumulative incidence of valve dysfunction was lower in patients who underwent TAVI than in those who underwent surgery (subdistribution hazard ratio [sHR], 0.57; P < .001) through 5 years.When evaluating the components of valve dysfunction, patients who underwent TAVI had a lower 5-year incidence of structural valve deterioration (sHR, 0.54; P = .01) and nonstructural valve dysfunction (sHR, 0.55; P < .001) than those who underwent surgery.In the overall cohort of patients who underwent TAVI or surgery, valve dysfunction was associated with a 49%, 76%, and 48% increase in the hazard of 5-year all-cause mortality, cardiovascular mortality, and hospitalization for valve disease or worsening heart failure, respectively (P < .001 for all).Among patients who developed valve dysfunction, the surgery cohort showed a higher relative risk for all-cause and cardiovascular mortality than the TAVI cohort (P < .001 for both).IN PRACTICE:“Although long-term 10-year follow-up is ongoing, the correlation of valve performance with 5-year clinical outcomes should be a key consideration in selecting the first bioprosthetic valve in patients with symptomatic severe AS [aortic stenosis] undergoing aortic valve replacement,” the authors wrote. SOURCE:This study was led by Steven J. Yakubov, MD, from Riverside Methodist, OhioHealth in Columbus, Ohio. It was published online on March 09, 2025, in the Journal of the American College of Cardiology. LIMITATIONS:Echocardiographic examinations were unavailable for some of the trials and at certain follow-ups. This study included predominantly older patients, and the true incidence of valve dysfunction may not be extrapolated to a broader population. The findings may not have represented outcomes with current-generation Evolut valves as most of the patients who underwent TAVI received early-generation CoreValve bioprosthesis. DISCLOSURES:This study was supported by Medtronic, United States. Several authors reported receiving research grants, personal fees, consulting fees, and honoraria from; being employees of; serving on the advisory board of; and being shareholders of Medtronic. Many authors reported having financial ties with other medical device and heart care companies including Boston Scientific, Edwards Lifesciences, and Abbott Vascular. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.