Valvular & structural heart diseaseMeta-analysis
Impact of Transcatheter or Surgical Aortic Valve Performance on 5-Year Outcomes in Patients at ≥ Intermediate Risk
- Post hoc pooled analysis of randomised trials and a continued access study
- pooled data
Authors' conclusion
Five-year valve performance was significantly better after CoreValve/Evolut TAVR compared with surgery. Development of BVD in TAVR and surgery patients was associated with worsened 5-year clinical outcomes.
Study context
- Population
- Patients at ≥ intermediate risk undergoing transcatheter aortic valve replacement (TAVR) or surgery (U.S. High Risk Pivotal, SURTAVI, Extreme Risk Pivotal, CoreValve Continued Access Study)2,344 RCT, 3,262 non-RCT TAVR
- Participants
- 5,606 patients
- Comparison
- CoreValve/Evolut TAVR vs surgery
- TAVRn = 1,227
- Surgeryn = 1,117reference
- Outcome
- Incidence of bioprosthetic valve dysfunction (BVD) from the randomized controlled trials (RCTs)
- Follow-up
- Through 5 years
Pooled result
BVD (RCT patients) · 5 years
Subdistribution hazard ratio
0.57
95% CI 0.45–0.73
P < 0.001
By group
TAVR vs Surgery
subdistribution HR 0.57 (95% CI 0.45–0.73); P < 0.001
As reported in the abstract
Further pooled results
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| BVD vs no BVD and 5-year outcomes (pooled RCT and non-RCT cohort) · all-cause mortality | 1.49 (1.32–1.68) | P < 0.001 | |
| BVD vs no BVD and 5-year outcomes (pooled RCT and non-RCT cohort) · CV mortality | 1.76 (1.52–2.03) | P < 0.001 | |
| BVD vs no BVD and 5-year outcomes (pooled RCT and non-RCT cohort) · hospitalization for valve disease or worsening HF | 1.48 (1.23–1.78) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
Original publication
Impact of Transcatheter or Surgical Aortic Valve Performance on 5-Year Outcomes in Patients at ≥ Intermediate Risk. J Am Coll Cardiol. Published 9 March 2025. doi:10.1016/j.jacc.2025.02.009
Summarised from the published abstract; every number is checked against it