New Trials Reveal Surprising Findings in TAVR and Aortic Stenosis Treatment

Follow-up data from the PARTNER 3 and Evolut trials presented at TCT 2023 showed that transcatheter aortic valve implantation (TAVI) remains a safe and effective treatment option for low-risk patients with severe aortic stenosis. The PARTNER 3 trial demonstrated no significant difference in the risk of death, stroke, or rehospitalizations between TAVI and surgical aortic valve replacement (SAVR) at 5 years. However, there was an attenuation of the differences in the primary composite endpoint beyond 1 year, and numerically more deaths were observed in the TAVI group. In contrast, the Evolut Low Risk trial showed that TAVI with a self-expanding bioprosthesis was noninferior to SAVR in terms of all-cause mortality and disabling stroke at 4 years, with a sustained benefit and increasing advantage over time. The differences in outcomes between the two trials highlight the need for cautious interpretation and further investigation.