Six-Year Outcomes After Transcatheter vs Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis

Forrest, JK; Yakubov, SJ; Deeb, GM; Reardon, MJ; Evolut Low Risk Trial Investigators

doi:10.1016/j.jacc.2026.02.5063

Valvular & structural heart disease

Six-Year Outcomes After Transcatheter vs Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis

J Am Coll CardiolPublished 16 Feb 2026Secondary analysis of the Evolut Low Risk randomised trial

Primary result · All-cause mortality or disabling strokeResultDifference 2.8% 95% CI −1.9% to 7.6%

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Authors' conclusion

The 6-year results from the Evolut Low Risk trial show no significant difference in the composite endpoint of all-cause mortality or disabling stroke.

Study context

Population: Low-risk patients with severe symptomatic AS, randomised 2016–2019attempted implantation
Participants: 1,414 patients

Comparison: Transcatheter aortic valve replacement (TAVR) vs surgery
TAVRn = 730
Surgeryn = 684reference
Primary endpoint: All-cause mortality or disabling stroke
Follow-up: 6 years

Methodological detailsprespecified 6-year analysis, additional analysis of available 7-year data

Prespecified 6-year analysis
Additional analysis of available 7-year data

Primary result

As reported in the abstract

Difference

2.8%

95% CI −1.9% to 7.6%

P = 0.43

By group

TAVR23.3%

Surgery20.4%

TAVRvs Surgery

difference 2.8% (95% CI −1.9% to 7.6%); P = 0.43

Secondary outcomes

Outcome	TAVR	Surgery	← Lower risk with TAVR ←→ Higher risk with TAVR →	sHR (95% CI)	P value
Reintervention · 6 yearsCumulative incidence	5.5%	3.3%	0.10.31310	1.66 (0.96–2.86)	P = 0.07
Reintervention · 7 years	9.8%	6.0%	0.10.31310	1.68 (1.10–2.58)	P = 0.02
Reintervention for regurgitation · 7 years	5.6%	1.6%	0.10.31310	3.39 (1.62–7.07)	P < 0.001
Reintervention for stenosis · 7 years	3.6%	3.5%	0.10.31310	1.14 (0.61–2.15)	P = 0.70
			0.10.31310Subdistribution hazard ratio (log scale)

Outcome	TAVR	Surgery	P value
All-cause mortality (with vital status sweep) · 6 years	— not stated in the abstract	20.2% (95% CI 17.4%–23.3%)	P = 0.24

— not stated in the abstract

Reintervention: available 7-year follow-up: 555 TAVR, 480 surgery

Original publication

Six-Year Outcomes After Transcatheter vs Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis. J Am Coll Cardiol. Published 16 February 2026. doi:10.1016/j.jacc.2026.02.5063

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