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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

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Isolated Transcatheter and Surgical Aortic Valve Replacement in the Evolut Low-Risk Trial: 5-Year Comparative

Basel Ramlawi1, G Michael Deeb2, Steven J Yakubov3

  • 1Department of Cardiovascular Surgery, Lankenau Heart Institute, Philadelphia, Pennsylvania.

The Annals of Thoracic Surgery
|April 17, 2026
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) show similar 5-year survival and reintervention rates in low-risk patients. TAVR had higher pacemaker needs, but paravalvular regurgitation was comparable.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Devices

Background:

  • Severe aortic stenosis necessitates valve replacement.
  • Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are primary treatment options.
  • Low-risk patient populations are increasingly candidates for TAVR.

Purpose of the Study:

  • To compare the 5-year clinical and echocardiographic outcomes of isolated TAVR versus isolated SAVR in low-risk patients.
  • To evaluate the safety and efficacy of TAVR compared to SAVR in a low-risk cohort.
  • To assess long-term results including mortality, stroke, reintervention, and valve function.

Main Methods:

  • Post hoc analysis of the Evolut Low Risk Trial.
  • Inclusion of 1,164 low-risk patients who underwent isolated TAVR (667) or SAVR (497).
  • Exclusion of patients with concomitant procedures or treatment arm crossover.

Main Results:

  • At 5 years, the composite of all-cause mortality or disabling stroke was similar: 15.5% for TAVR vs. 14.6% for SAVR (P=.84).
  • All-cause mortality (13.5% vs. 12.8%) and cardiovascular mortality (6.9% vs. 8.3%) were comparable.
  • New permanent pacemaker implantation was significantly higher with TAVR (27.3% vs. 8.9%, P<.001).
  • Aortic valve reintervention rates (3.0% vs. 2.2%, P=.51) and moderate/greater paravalvular regurgitation (0.5% vs. 0%, P=.52) were similar.

Conclusions:

  • Isolated TAVR and SAVR demonstrate comparable 5-year outcomes regarding mortality, reintervention, and paravalvular regurgitation in carefully selected low-risk patients.
  • Evolut TAVR is a suitable option for isolated valve replacement in this population.
  • Higher rates of pacemaker implantation with TAVR require consideration in patient selection.
Abstract

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