Transfemoral transcatheter aortic-valve replacement should be preferred over surgery in most intermediate-risk patients.

Commentary on: Leon MB, Smith CR, Mack MJ, et al., PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 2016;374:1609–20[OpenUrl][1][CrossRef][2][PubMed][3]. Evidence derived from randomised clinical trials support transcatheter aortic valve replacement (TAVR) as a choice for patients with aortic stenosis with a prohibitive surgical risk and as a valid alternative therapy for those at high-risk of surgical mortality. Owing to increases in operator experience as well as improvements with transcatheter techniques and devices associated with reduction in procedural complications, TAVR has been progressively extended to less risky patients,1 despite the lack of rigorous clinical-trial assessment of this expansion. In the Placement of Aortic Transcatheter Valves 2 (PARTNER-2) Cohort A randomised trial, safety and effectiveness of TAVR with a lower-profile second-generation valve system were compared with conventional surgical aortic valve replacement (SAVR) in patients with intermediate-risk clinical … [1]: {openurl}?query=rft.jtitle%253DN%2BEngl%2BJ%2BMed%26rft.volume%253D374%26rft.spage%253D1609%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJMoa1514616%26rft_id%253Dinfo%253Apmid%252F27040324%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1056/NEJMoa1514616&link_type=DOI [3]: /lookup/external-ref?access_num=27040324&link_type=MED&atom=%2Febmed%2F21%2F5%2F173.atom