Outcomes among low-risk patients who undergo transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) remain comparable eight years after treatment, according to new findings published in European Heart Journal.
“The limited data on long-term clinical outcomes after [TAVR] compared to SAVR, as well as the durability of transcatheter heart valves (THVs), have been raised as a concern for expansion of [TAVR] to patients with longer life expectancy,” wrote lead author Troels Højsgaard Jørgensen, MD, a cardiologist at Copenhagen University Hospital in Denmark, and colleagues. “Despite this, the use of [TAVR] in younger patients at low surgical risk is unlikely to be delayed, and therefore long-term data are increasingly important.”
The original NOTION trial included 280 low-risk patients with aortic valve stenosis randomized to either undergo TAVR or SAVR from 2009 to 2013. For this updated analysis, Jørgensen et al. examined the long-term outcomes of each procedure by reviewing patient data after eight years.
Overall, the group found, the composite outcome of all-cause mortality, stroke or myocardial infarction (MI) after eight years was seen in 54.5% of TAVR patients and 54.8% of SAVR patients. The estimated risks for all-cause mortality, stroke and MI all also remained similar.
In addition, the team found, the risk of bioprosthetic valve failure (BVF) was similar between the two patient groups. The risk of structural valve deterioration was lower after TAVR (13.9%) than surgery (28.3%), however, providing one of the key long-term differences between these two treatment options.
“The long-term results are reassuring for [TAVR] both regarding clinical outcomes and THV durability, as [TAVR] is now indicated for patients with longer life expectancy,” the authors concluded. “Still, further long-term data are needed including data on all types of THVs.”
The full analysis is available here.
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