Impact of Transcatheter or Surgical Aortic Valve Performance on 5-Year Outcomes in Patients at ≥ Intermediate Risk

Yakubov, SJ; Van Mieghem, NM; Oh, JK; Ito, S; Grubb, KJ; O'Hair, D; Forrest, JK; Gada, H; Mumtaz, M; Deeb, GM; Tang, GHL; Rovin, JD; Jain, R; Windecker, S; Skelding, KA; Kleiman, NS; Chetcuti, SJ; Dedrick, A; Boatman, SV; Popma, JJ; Reardon, MJ

doi:10.1016/j.jacc.2025.02.009

Valvular & structural heart disease

Impact of Transcatheter or Surgical Aortic Valve Performance on 5-Year Outcomes in Patients at ≥ Intermediate Risk

J Am Coll CardiolPublished 9 Mar 2025Post hoc pooled analysis of randomised trials and a continued access study

Pooled result · BVD (RCT patients)ResultSubdistribution hazard ratio 0.57 95% CI 0.45–0.73

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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

Methodological detailspooled data

Pooled data

Pooled result

BVD (RCT patients) · 5 years

Subdistribution hazard ratio

0.57

95% CI 0.45–0.73

P < 0.001

By group

TAVR9.7%

Surgery15.3%

TAVRvs Surgery

subdistribution HR 0.57 (95% CI 0.45–0.73); P < 0.001

As reported in the abstract

Further pooled results

Outcome	← Lower risk with BVD ←→ Higher risk with BVD →	HR (95% CI)	P value
BVDvs no BVD and 5-year outcomes (pooled RCT and non-RCT cohort)All-cause mortality	0.512	1.49 (1.32–1.68)	P < 0.001
BVDvs no BVD and 5-year outcomes (pooled RCT and non-RCT cohort)CV mortality	0.512	1.76 (1.52–2.03)	P < 0.001
BVDvs no BVD and 5-year outcomes (pooled RCT and non-RCT cohort)Hospitalization for valve disease or worsening HF	0.512	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

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