Long-term outcomes after transcatheter aortic valve replacement.

Abstract

Transcatheter aortic valve replacement (TAVR) is a more prevalent procedure than surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS). With increasing TAVR utilization in young and low-risk patients, understanding long-term outcomes of TAVR is critical. Three randomized TAVR vs SAVR trials in patients with severe AS were identified with outcomes reported beyond 5 years: the NOTION (10-year outcomes), PARTNER 3 (7-year outcomes), and Evolut Low-Risk (6 year overall outcomes and 7 year reintervention data) trials. Primary trial outcomes, all of which were composite outcomes including all-cause mortality, stroke, myocardial infarction, and/or valve-, procedure-, or heart failure-related readmission, demonstrated similar outcomes between TAVR and SAVR (NOTION: 65.5% vs 65.5%, P = 0.9; PARTNER 3: 34.6% vs 37.2%, HR 0.87 [95% CI 0.70-1.08]; Evolut Low Risk: 23.3% vs 20.4%, P = 0.43). Amongst secondary outcomes, the cumulative incidence of TAVR reintervention was similar to SAVR reintervention in the NOTION trial (4.3%vs 2.2%, P = 0.3) and the PARTNER 3 trial (6.7%vs 6.0%, HR 1.11 [0.63-1.94]), but TAVR reintervention was higher than SAVR reintervention in the Evolut Low-Risk trial (9.8%vs 6.0%; p = 0.02). Study limitations include small cohort size (145 undergoing TAVR) of older patients undergoing TAVR with early generation self-expanding TAVRs in the NOTION trial and no data yet beyond 7 years in the PARTNER 3 and Evolut Low-Risk trials. Despite limitations, these data highlight the criticality in extremely careful patient selection for TAVR to optimize long term outcomes in the era of lifetime management of AS.