Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Low Surgical Risk Patients With Severe Aortic Stenosis: A Literature Review

Abstract

Aortic stenosis is among the most common valvular heart diseases and, if untreated, can lead to reduced quality of life and potential heart failure. Surgical Aortic Valve Replacement (SAVR) has long been recognized as the standard treatment for severe aortic stenosis, while Transcatheter Aortic Valve Replacement (TAVR) has recently emerged as a less invasive alternative, being offered more often as a treatment option for low surgical risk patients. This review evaluates current evidence comparing TAVR and SAVR in low surgical risk patients with severe aortic stenosis, comparing mortality, neurological outcomes, recovery, procedural complications, and valve durability. Evidence from the PARTNER 3 Trial and the Evolut Low Risk Trial demonstrates that TAVR provides clinical outcomes comparable to SAVR in low surgical risk patients. While having similar mortality and stroke rates, TAVR results in earlier recovery and quality of life; however, it also comes with higher rates of permanent pacemaker implantation and paravalvular leak which are important factors when choosing a treatment option. Current five-year data shows strong valve performance, although additional long-term data will be needed to better evaluate durability in younger patients. Overall, current evidence demonstrates TAVR is a safe and effective alternative to SAVR for carefully selected low surgical risk patients with severe aortic stenosis, but the decision should ultimately be made by a heart team on a case-by-case basis.