Five-Year Outcomes Similar With TAVR, Surgery in Low-Risk Patients

THURSDAY, Nov. 2, 2023 (HealthDay News) -- For patients with severe, symptomatic aortic stenosis at low surgical risk, five-year outcomes are similar with transcatheter aortic-valve replacement (TAVR) versus surgical aortic valve replacement, according to a study published online Oct. 24 in the New England Journal of Medicine to coincide with the annual Transcatheter Cardiovascular Therapeutics conference, held from Oct. 23 to 26 in San Francisco.

Michael J. Mack, M.D., from Baylor Scott and White Health in Plano, Texas, and colleagues randomly assigned patients with severe, symptomatic aortic stenosis and low surgical risk to undergo TAVR or surgery (503 and 497, respectively). Outcomes were assessed through five years.

The researchers found that a component of the first primary end point (composite of death, stroke, or rehospitalization related to the valve, the procedure, or heart failure) occurred in 22.8 and 27.2 percent of patients in the TAVR and surgery groups, respectively (difference, −4.3 percentage points). For the second primary end point (a hierarchical composite that included death, disabling stroke, nondisabling stroke, and the number of rehospitalization days), the win ratio was 1.17. For the components of the first primary end point, the Kaplan-Meier estimates were 10.0 and 8.2 percent in the TAVR and surgery groups, respectively, for death; 5.8 and 6.4 percent, respectively, for stroke; and 13.7 and 17.4 percent, respectively, for rehospitalization.

"[Our findings] support routinely offering TAVR, even to patients for whom open-heart surgery wouldn't pose a high risk," senior author Raj Makkar, M.D., from the Cedars-Sinai Medical Center in Los Angeles, said in a statement.

Several authors disclosed ties to pharmaceutical and medical device companies, including Edwards Lifesciences, which funded the study.

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