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Randomized, controlled trials have demonstrated that patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) have similar outcomes to those undergoing surgical aortic valve replacement (SAVR) at 5 years, but long-term TAVR durability is unknown. Now, investigators for the manufacturer-funded, randomized PARTNER 3 trial report 7-year outcomes in a population of 1000 patients with severe, symptomatic aortic stenosis at low surgical risk.
The incidence of a composite primary endpoint, including death, stroke, or rehospitalization related to the procedure, the valve, or heart failure, was similar with TAVR and SAVR (35% vs. 37%), with no differences in any of the individual component outcomes.
The mean echo aortic valve gradient was similar (TAVR, 13 mm Hg; SAVR, 12 mm Hg).
Paravalvular aortic regurgitation was more common in the TAVR group (17% vs. 2%), mostly driven by mild regurgitation.
The cumulative incidence of bioprosthetic valve failure was similar (≈7%).
Note: David J. Cohen and Howard S. Herrmann, Associate Editors of NEJM Clinician, are coauthors of this article but were not involved in its selection or summarization.
Leon MB, et al. Transcatheter or surgical aortic-valve replacement in low-risk patients at 7 years. N Engl J Med 2025 Oct 27; [e-pub] 10.1056/NEJMoa2509766.41144631
Comment
These data showing longer-term TAVR durability in a low-risk surgical population will be valuable in counseling patients. With this evidence in hand, I expect that most of my older patients will now choose TAVR over surgery. However, I will caution my younger patients about the higher rates of paravalvular leak with TAVR and the need for even longer-term data to see if these leaks reflect worse durability.