Comparing TA-TAVR and SAVR in severe aortic regurgitation: outcomes and valve haemodynamics

Transcatheter aortic valve replacement (TAVR) has already been recommended for some high-risk patients with aortic valve regurgitation, but there is still a lack of evidence regarding its early-term and medium-term safety and effectiveness compared with surgical aortic valve replacement (SAVR).

This retrospective study included patients who underwent bioprosthetic aortic valve replacement for severe aortic regurgitation (AR) at a single centre between January 2018 and December 2023. All patients in the TAVR group received the J-Valve system via transapical (TA) approach. Propensity score matching (PSM) was used to balance the groups. The primary endpoint was 2-year all-cause mortality. Secondary endpoints included other clinical events, left ventricular (LV) function recovery and prosthesis haemodynamics, assessed by transthoracic echocardiography.

A total of 369 patients (median age 68 years, 26.6% female) were enrolled. Of these, 256 underwent TA-TAVR and 113 underwent SAVR. After 1:1 PSM, 76 matched pairs were included. There were no statistical differences between the groups in all-cause mortality, cardiovascular mortality, stroke, heart failure rehospitalisation, permanent pacemaker implantation or moderate to severe paravalvular leakage at 30 days or 2 years. Before PSM, left ventricular ejection fraction (LVEF) improved in the TAVR group (57% (IQR: 45-63%) vs 61% (IQR: 55-65%), p<0.001), with no significant change in the SAVR group (61% (IQR: 55-65%) vs 62% (IQR: 59-66%), p>0.05). After PSM, LVEF improvement was comparable between groups (+4.0% (IQR: -1.5 to 10.0) vs +2.0% (IQR: -3.0 to 9.5), p=0.430). Haemodynamics was superior in the TAVR group (p<0.001), while regression of LV dimensions was greater in the SAVR group.

In patients with severe AR, using the J-Valve for TA-TAVR showed comparable outcomes to SAVR regarding mortality and other clinical events. TAVR provided superior valve haemodynamics and was an effective treatment that significantly improved LV function, especially in high-risk patients.