TAVR at 5 Years — Rematch or Swan Song for Surgery?

This editorial reviews 5-year data from the PARTNER 2 cohort A trial comparing transcatheter aortic-valve replacement (TAVR) using the SAPIEN XT valve to surgical aortic-valve replacement in intermediate-risk patients. While initial outcomes showed noninferiority, later event rates diverged unfavorably for TAVR, driven in part by higher incidences of moderate or mild paravalvular regurgitation, conditions correlated with increased mortality. TAVR patients had more valve-related hospitalizations and reinterventions, and the trial design allowed more complete surgical treatments. Despite favorable hemodynamic performance, durability concerns persist. Limitations in trial applicability include older-generation valves and procedural approaches no longer used. The editorial concludes that while TAVR has transformed aortic stenosis therapy, longer-term drawbacks must be resolved before it can fully replace surgery as the gold standard.

This editorial reviews 5-year data from the PARTNER 2 cohort A trial comparing transcatheter aortic-valve replacement (TAVR) using the SAPIEN XT valve to surgical aortic-valve replacement in intermediate-risk patients. While initial outcomes showed noninferiority, later event rates diverged unfavorably for TAVR, driven in part by higher incidences of moderate or mild paravalvular regurgitation, conditions correlated with increased mortality. TAVR patients had more valve-related hospitalizations and reinterventions, and the trial design allowed more complete surgical treatments. Despite favorable hemodynamic performance, durability concerns persist. Limitations in trial applicability include older-generation valves and procedural approaches no longer used. The editorial concludes that while TAVR has transformed aortic stenosis therapy, longer-term drawbacks must be resolved before it can fully replace surgery as the gold standard.