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Valvular & structural heart diseaseSecondary analysis

Outcomes of Early vs Delayed Aortic Valve Replacement

JACC Cardiovasc IntervPublished

  • Secondary analysis of the EARLY transcatheter aortic valve replacement (TAVR) randomised trial
  • multicentre
  • valve implant population

97.6% of early TAVR patients (444 of 455) underwent the index procedure; 87.0% of clinical surveillance (CS) patients (388 of 446) underwent delayed aortic valve replacement (AVR) through 5 years

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Authors' conclusion

Among patients with asymptomatic, severe AS, delayed AVR with AVS is associated with higher rates of death, stroke, or heart failure hospitalization compared with early TAVR

Study context

Population
Patients with asymptomatic, severe aortic stenosis (AS) undergoing valve implant, 75 sites75 sites
Participants
444 vs 388
Comparison
Early TAVR vs delayed AVR after clinical surveillance
  • Early TAVRn = 444reference
  • Delayed AVRn = 388
Primary endpoint
Composite of:
  • Death
  • Stroke
  • HF hospitalization
Follow-up
2 years postprocedure

Primary result

Death, stroke or HF hospitalization

Adjusted hazard ratio

0.61

95% CI 0.38–0.99

P = 0.045

Early TAVR vs Delayed AVR
adjusted HR 0.61 (95% CI 0.38–0.99); P = 0.045

As reported in the abstract

Further findings

Outcomeadjusted HR (95% CI)P value
Primary composite by presentation: delayed AVR with acute valve syndrome (AVS) vs early TAVR — Delayed AVR with AVS vs Early TAVR2.12 (1.19–3.78)P = 0.01
Primary composite by presentation: delayed AVR with acute valve syndrome (AVS) vs early TAVR — Delayed AVR with AVS vs Early TAVR · stroke2.92 (1.26–6.76)P = 0.01
  • Primary composite by presentation: delayed AVR with acute valve syndrome (AVS) vs early TAVR: 39.2% of delayed AVR presented with AVS, 58.5% with progressive valve syndrome
  • Primary composite by presentation: delayed AVR with acute valve syndrome (AVS) vs early TAVR: median time to delayed AVR 11.1 months

Original publication

Outcomes of Early vs Delayed Aortic Valve Replacement. JACC Cardiovasc Interv. Published 24 November 2025. doi:10.1016/j.jcin.2025.09.029
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Summarised from the published abstract; every number is checked against it