Transcatheter Aortic-Valve Replacement in Low-Risk Patients at Five Years
Abstract
The PARTNER 3 trial randomized 1000 patients with severe, symptomatic aortic stenosis and low surgical risk to receive either transfemoral TAVR using the SAPIEN 3 valve or surgical aortic-valve replacement. Primary composite endpoint at 5 years: death, stroke, or rehospitalization occurred in 22.8% (TAVR) vs. 27.2% (surgery) (HR 0.79; 95% CI: 0.61–1.02; P=0.07)—not statistically significant. A second hierarchical composite endpoint (win ratio analysis) also showed no significant difference (Win ratio 1.17; 95% CI: 0.90–1.51; P=0.25). Individual outcomes at 5 years:
Death: 10.0% (TAVR) vs. 8.2% (surgery)
Stroke: 5.8% vs. 6.4%
Rehospitalization: 13.7% vs. 17.4%
Bioprosthetic valve failure: 3.3% (TAVR) vs. 3.8% (surgery)
Paravalvular regurgitation (mild+): 24.5% (TAVR) vs. 6.3% (surgery)
Valve thrombosis: 2.5% (TAVR) vs. 0.2% (surgery)
New-onset atrial fibrillation: 13.7% (TAVR) vs. 42.4% (surgery)
Pacemaker implantation: 13.5% (TAVR) vs. 10.4% (surgery)
Serious bleeding: 10.2% (TAVR) vs. 14.8% (surgery) Hemodynamic valve function and quality-of-life measures (KCCQ-OS ~86) remained stable and similar between groups.
The trial concludes TAVR and surgery show comparable 5-year outcomes in low-risk patients, with no significant difference in mortality or stroke. Durability and symptom relief were sustained across both modalities. Longer-term surveillance continues.