After 3 years, patients who underwent transcatheter aortic valve replacement (TAVR) demonstrated greater benefit than those who underwent surgery with respect to all-cause mortality or disabling stroke, a new study shows. John K. Forrest, MD, of the Yale New Haven Health System, New Haven, Connecticut, reported these data during a Late-Breaking Clinical Trial presentation Sunday at the American College of Cardiology Scientific Sessions 2023 in New Orleans. A manuscript reporting these findings was simultaneously published online in the Journal of the American College of Cardiology. Studies on differences in patient outcomes post-TAVR versus post-surgery are minimal after 2 years. TAVR has become the dominant form of therapy over surgery in these patients, but the faster recovery and short-term benefits after TAVR must be balanced with long-term valve durability, Forrest said. The Evolut low-risk trial was a multicenter, multinational study that investigated the long-term (after 3 years) outcomes in low-risk patients who underwent TAVR with the self-expanding CoreValve or Evolut R or PRO valves or surgery for AS. The original primary endpoint the composite of death or disabling stroke at 2 years, showed that TAVR with these valves was noninferior to surgery. The study was funded by the valves’ manufacturer, Medtronic. The primary endpoint of the study reported Sunday was all-cause mortality or disabling stroke at 3 years. There were 1,414 patients in the study (TAVR group=730, surgery group=684; mean age = 74 years; 35% women). In the TAVR group, 7.4% of patients had primary endpoint occurrence, and this occurred in 10.4% of patients in the surgery group (hazard ratio [HR]=0.70; 95% confidence interval [CI]=0.49-1.00; p=0.051). There was little difference between the two groups for all-cause mortality or disabling stroke over years 1, 2 and 3. The surgery group patients experienced fewer instances of mild paravalvular regurgitation and pacemaker placement (20.3% TAVR versus 2.5% surgery; p<0.001). The two groups did not differ in rates of moderate or greater paravalvular regurgitation. TAVR patients had better hemodynamics (9.1 mmHg mean gradient TAVR, 12.1 mmHg mean gradient surgery) at 3 years. Overall, low-risk patients who underwent TAVR had more sustainable benefits with regard to all-cause mortality and disabling stroke compared with patients who underwent surgical aortic valve replacement. “Patients with severe aortic stenosis who are at low surgical risk should continue to engage in shared decision-making with their physicians concerning the risks and benefits of surgical versus transcatheter valve replacement,” Forrest said in a news release announcing the results. Source: Forrest JK, Deeb GM, Yakubov SJ, et al. Three-Year Outcomes after Transcatheter of Surgical Aortic Valve Replacement in Low-Risk Patients with Aortic Stenosis. J Am Coll Cardiol. 2023 Mar 5 (Article in press).