Objective analysis of frailty-based 10-year outcomes of transcatheter and surgical aortic valve replacement

To compare the long-term outcomes of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS) by adjusting not only for conventional risk scores but also for frailty, cognitive function, nutritional status, and comorbidities.

This retrospective single-center study included 1258 patients (SAVR, n = 446; TAVI, n = 812) who underwent isolated elective procedures for AS between January 2014 and December 2024. Propensity score matching (1:1) was performed based on 19 baseline variables including age, Society of Thoracic Surgeons risk score, Clinical Frailty Scale, Mini-Mental State Examination, and Geriatric Nutritional Risk Index. The primary endpoint was a composite of all-cause mortality and cardiac readmission over a follow-up period of up to 10 years.

After matching, 114 patient pairs were obtained. The SAVR group had longer intensive care unit and hospital stays. However, there were no significant differences in 30-day mortality, stroke, pacemaker implantation, or readmission rates. Over long-term follow-up, a significantly better survival rate was seen in the SVAR group compared to the TAVI group (hazard ratio [HR], 0.16; 95% confidence interval [CI], 0.49-0.58; P = .005), while the readmission rate was similar in the 2 groups (HR, 1.0; 95% CI, 0.40-1.69; P = .93).

After comprehensive adjustment for frailty, cognitive function, and nutritional status, SAVR demonstrated superior long-term survival compared to TAVI, with comparable readmission rates. Personalized treatment strategies for AS should incorporate broader patient-specific factors to guide optimal therapeutic decision making.