Transcatheter aortic valve replacement (TAVR) may be a better treatment option than sutureless surgical aortic valve replacement (SU-SAVR) for low-risk patients with aortic stenosis, according to new findings published in Circulation: Cardiovascular Interventions.
“Sutureless valves were poorly represented in TAVR-SAVR randomized trials, and controversial data exist comparing the outcomes associated with TAVR and SU-SAVR,” wrote lead author Victoria Vilalta, an interventional cardiologist at Hospital Universitari Germans Trias i Pujol in Spain, and colleagues. “Also, most data available relates to intermediate- to high-risk patients and is limited to early (in-hospital) outcomes. Thus, the long-term clinical impact of these therapeutic options in lower risk patients remains largely unknown.”
Vilalta et al. explored data from more than 800 patients who underwent TAVR or SU-SAVR at one of two facilities from 2011 to 2020. The team then matched 171 pairs of patients together to make any comparisons as accurate as possible.
Overall, the group found that in-hospital mortality and stroke rates were similar between the two treatment options. SU-SAVR, however, was associated with higher rates of bleeding events and new-onset atrial fibrillation. After a median follow-up period of two years, TAVR and SU-SAVR had comparable rates of all-cause mortality and stroke, but SU-SAVR patients were more likely to be hospitalized for heart failure.
“These data go in the same direction as previous randomized TAVR-SAVR trials in low-risk patients and would support TAVR over SU-SAVR in the majority of such patients,” the authors wrote. “The choice of SU-SAVR in low-risk patients should be determined by individual factors such as patient-specific anatomic considerations leading to an increased risk of suboptimal results with TAVR.”
The full analysis can be read here.
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