Transcatheter aortic valve replacement (TAVR) has become the standard of care for patients with severe aortic stenosis and high surgical risk, and it should be considered as an option for intermediate-risk patients. In recent years, the number of low-risk patients treated with TAVR has increased. This study analyzes low-risk patients from the German Aortic Valve Registry (GARY) who underwent isolated TAVR vs. surgical treatment.

All patients with a Society of Thoracic Surgeons (STS) score <4% between 2014 and 2015 were analyzed. The result was a total of 20,549 subjects: 14,487 underwent surgery and 6062 underwent TAVR.

Patients who underwent TAVR were significantly older and had more comorbidities, so propensity score matching was used to compare in-hospital mortality at 30 days and at 1 year.

TAVR patients showed significantly higher survival rates, both in-hospital and at 30 days, than patients who underwent conventional surgery (in-hospital survival for TAVR vs. surgery: 98.5% vs. 97.3%; p = 0.003; 30-day survival for TAVR vs. surgery: 98.1% vs. 97.1%; p = 0.014).

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At one year, mortality was similar for both methods (90.0% vs. 91.2%; p = 0.158).

Conclusion

This first GARY Registry analysis of low-risk patients showed similar mortality for surgery and transcatheter aortic valve replacement.

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Original Title: Patients at low surgical risk as defined by the Society of Thoracic Surgeons Score undergoing isolated interventional or surgical aortic valve implantation: in-hospital data and 1-year results from the German Aortic Valve Registry (GARY).

Reference: Raffi Bekeredjian et al. European Heart Journal (2019) 40, 1323–1330.

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