Garcia S, et al. - This study entailed comparison of the outcomes of surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) among patients with intermediate surgical risk treated in the VA Healthcare System. Findings suggested that significant improvements in morbidity and mortality may be seen with TAVR in intermediate-risk patients.

Methods

• All SAVR (1987–2014) and TAVR procedures (2015–2017) performed at the Minneapolis VA Healthcare System were retrospectively analyzed for clinical characteristics and outcomes.
• On the basis of patients' estimated 30-day mortality risk, they were divided into 3 groups.
• A composite of death or stroke at 30-days was the primary outcome.

Results

• During the study period, SAVR with (n = 468, 45%) or without CABG (n = 581, 55%) was performed on a total of 1,049 patients and 110 underwent TAVR.
• Findings showed that 29.4% and 40% of patients undergoing SAVR and TAVR, respectively, were acknowledged as intermediate-risk patients.
• For the SAVR group and the TAVR group (P=0.54), the predicted 30-day mortality risk of intermediate-risk patients was 5.5% and 5.2%, respectively.
• Researchers found that the combined rate of stroke or death at 30-days for intermediate-risk patients treated with SAVR and TAVR was 11% and 2.2%, respectively (P=0.05).
• They also noted that the outcomes for SAVR and TAVR at the VA were comparable to the P2 trial and STS database (all P=NS).
• Restricting analysis to a more contemporary (2005–2014) surgical cohort or isolated SAVR did not alter the results.
• Data reported that the number needed to treat to prevent 1 death/stroke with TAVR was 10.