Valvular & structural heart disease
5-Year Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients
Authors' conclusion
In low-risk patients with severe aortic stenosis, TAVR, compared to surgery, was associated with similar, stable valve hemodynamics at 5 years with less frequent low-flow state, lower valvulo-arterial impedance, and better right ventricular function.
Study context
- Population
- Low-risk patients with symptomatic, severe ASrandomized
- Participants
- 1,000 patients
- Comparison
- Transcatheter aortic valve replacement (TAVR) vs surgery
- Primary endpoint
- 5-year echocardiographic results (valve hemodynamics); clinical composite primary endpoint:
- Death
- Stroke
- Rehospitalization
- Follow-up
- 5 years
Methodological detailscore lab consortium echocardiographic analysis, Echocardiograms at baseline, 30 days, 1 year and annually through 5 years, analysed by a core lab consortium; composite primary endpoint adjudicated by a clinical events committee
- Core lab consortium echocardiographic analysis
- Echocardiograms at baseline, 30 days, 1 year and annually through 5 years, analysed by a core lab consortium; composite primary endpoint adjudicated by a clinical events committee
Primary result
As reported in the abstract
Echocardiographic results
≥ mild aortic regurgitation
P < 0.001
| Outcome | TAVR | Surgery | P value |
|---|---|---|---|
| Mean transaortic gradient | 12.8 ± 6.5 mm Hg | 11.7 ± 5.6 mm Hg | P < 0.001 |
| Stroke volume index | 44.6 ± 9.7 | 41.1 ± 9.2 | P < 0.0001 |
| Aortic valve area | 1.87 ± 0.46 | 1.82 ± 0.46 | P = 0.895 |
- TAVR vs Surgery: P < 0.001 — fewer low-flow stroke volume index with TAVR
- TAVR vs Surgery: P < 0.01 — less LV hemodynamic burden (valvulo-arterial impedance) with TAVR
- TAVR vs Surgery: P < 0.001 — higher tricuspid annular plane systolic excursion with TAVR
- TAVR vs Surgery: P < 0.0001 — higher RV-to-pulmonary artery coupling with TAVR
Further findings
30-day echo predictors of 5-year composite primary endpoint (combined cohorts)
- Moderate to severe prosthesis-patient mismatch, mild to severe aortic regurgitation or low stroke volume index at 30 days not predictive of clinical outcomes
- Low RV-to-pulmonary artery coupling and high valvulo-arterial impedance at 30 days associated with increased risk
Original publication
5-Year Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients. JACC Cardiovasc Imaging. Published 16 April 2025. doi:10.
Summarised from the published abstract; every number is checked against it