Treating of aortic valve stenosis in real-life: A multifaceted decision-making challenge

In this issue of CCI, Vejpongsa and coworkers showed that TAVR represented 20.4% of all aortic valve replacements performed in elderly patients from 21 US states in the year 2013. Patients treated with SAVR or TAVR largely overlapped in their baseline characteristics, indicating that both modalities concur in everyday life. One out of six patients was readmitted within 30 days, with no significant differences between the TAVR and SAVR in propensity score analysis. One may ask: since the indications of transcatheter and surgical treatments are interchanged for many cases, and the global results look similar, how to finally select the best therapeutic option for an individual case? Would the results be the same if patient-reported outcomes and experiences, such as pain and analgesic use, time to return to routine activities, or quality of life scores were measured? Combining traditional and patient-reported outcomes, in relation to costs, is the optimal approach to assess value in healthcare. Time has come for investigators to adopt value-based healthcare measures as endpoints in registries and clinical trials.