Surgical and transcatheter aortic valve replacement for severe aortic stenosis in low-risk elective patients: Analysis of the Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry

Abstract:

Objectives

Transcatheter aortic valve implantation (TAVI) remains the preferred strategy for high-risk or elderly individuals with aortic valve (AV) stenosis who are not considered to be optimal surgical candidates. Recent evidence suggests that low-risk patients may benefit from TAVI as well. The current study evaluates mid-term survival in low-risk elective patients undergoing surgical AV replacement (SAVR) vs TAVI.

Methods

The Aortic Valve replAcement in eLective patients from aOrtic valve multiceNter registry (AVALON) compared isolated elective transfemoral TAVI or SAVR with sternotomy or minimally-invasive approach in low-risk individuals performed between 2015 and 2019. Propensity score matching was conducted to determine SAVR controls for TAVI group in 1:3 ratio with 0.2 SD caliper.

Results

A total of 2,393 elective patients (1,765 SAVR and 629 TAVI) with median EuroSCORE II 1.81 (Interquartile range [IQR: 1.36-2.53]) were initially included. Median follow-up was 2.72 years ([IQR: 1.32-4.08], max 6.0). Propensity score matching returned 329 TAVI cases and 593 SAVR controls. 30-day mortality was 11/329 (3.32%) in TAVI and 18/593 (3.03%) in SAVR (Risk Ratio 1.10, 95% CI [0.52-2.37]; p=0.801) groups respectively. At 2 years, survival curves began to diverge in favor of SAVR, which was associated with 30% lower mortality (HR 0.70, 95% CI [0.496-0.997]; p=0.048)

Conclusions

Our data did not demonstrate a survival difference between TAVI and SAVR during the first two post-procedure years. After that time, SAVR is associated with improved survival. Extended observations from randomized trials in elective low-risk patients are warranted to confirm these findings and draw definitive conclusions.