Transcatheter Aortic Valve Replacement for Patients with Moderate Aortic Stenosis - a Propensity Matched Analysis: TAVR vs clinical surveillance for moderate AS.

Abstract

Moderate aortic stenosis (AS) has been linked to impaired long-term survival. Whether transcatheter aortic valve replacement (TAVR) may improve clinical outcome of moderate AS is unknown. We aimed to investigate the potential clinical benefits of TAVR for patients with moderate AS irrespective of LVEF. We used univariable and multivariable Cox regression models to find predictors for mortality and a composite of mortality and heart failure hospitalizations. We also performed a propensity score-matched comparison of outcomes between patients with moderate AS who underwent TAVR, and those with clinical surveillance with surgical aortic valve replacement or TAVR only upon progression to severe AS. We identified 115 patients with moderate AS who underwent TAVR and 220 patients with moderate AS who underwent clinical surveillance. TAVR patients were older, had more comorbidities and were more symptomatic than the clinical surveillance patients. TAVR was associated with lower all-cause mortality (multivariable adjusted HR: 0.51, 95%CI: 0.35-0.76) and reduced incidence of the composite endpoint of all-cause mortality and heart failure hospitalizations (adjusted HR: 0.53, 95%CI: 0.36-0.77). These results were reinforced in our propensity score matched analysis (unadjusted matched HR: 0.50, 95% CI: 0.33-0.75). In conclusion, TAVR may improve clinical outcome in patients with moderate AS. Our findings justify randomized controlled trials that evaluate TAVR in patients with moderate AS.