Original Title: Transcatheter Aortic Valve Implantation Compared With Surgical Aortic Valve Replacement in Low-Risk Patients.

Reference: Stefano Rosato et al. Circ Cardiovasc Interv. 2016 May;9(5):e003326.
The proved efficacy of transcatheter aortic valve implantation (TAVI) in high risk patients is leading the expansion of its indication for lower risk patients. All the same, compared to the information available on surgical valve replacement (SAVR), there is little evidence to support this change.

This analyzis describes TAVI vs. SAVR oucomes in low risk patients with severe aortic stenosis. It compared outcomes after TAVI and SAVR of low risk patients (European System for Cardiac Operative Risk Evaluation II [EuroSCORE II] <4%) incluided in the Observational Study of Effectiveness of SAVR–TAVI Procedures for Severe Aortic Stenosis Treatment (OBSERVANT).

Primary end point was survival at 3 years and secondary end point were early major cardiac and cerebrovascular events (MACCE) and at 3 years. 355 pairs of similar baseline characteristics were matched using propensity score.

Results
Survival at 30 days was 97.1% after SAVR and 97.4% after TAVI (p=0.82).
Cardiac tamponade, need of definite pacemaker, vascular complications and moderate to severe aortic regurgitation were significantly more frequent in patients receiving TAVI.
Even though stroke rate was the same in both groups, cardiogenic shock, major bleeding and acute kidney failure rates were higher with SAVR.
At 3 years, survival with SAVR was 83.4% vs. 72% with TAVI (p=0.0015). Freedom of MACCE was 80.9% for SAVR and 67.3% for TAVI (p<0.001).

Conclusion
In patients with symptomatic severe aortic stenosis and lower surgical risk, surgery showed significantly higher survival rates at 3 years compared to TAVI, according to this observational study.

More studies on new generation valve are necessary before expanding TAVI to lower risk patients.