Impact of aortic valve replacement in symptomatic low-risk patients with less than severe aortic stenosis.

Objective: To evaluate whether transcatheter or surgical aortic valve replacement (TAVR or SAVR) affects clinical and haemodynamic outcomes in symptomatic patients with moderately-severe aortic stenosis (AS).
Methods: Echocardiographic evidence of severe AS for enrolment in the Evolut Low Risk trial was based on site-reported measurements. For this post hoc analysis, core laboratory measurements identified patients with symptomatic moderately-severe AS (1.0<aortic valve area (AVA)<1.5 cm ² , 3.0<peak velocity<4.0 m/s and 20≤mean gradient (MG) <40 mm Hg). Clinical outcomes were reported through 2 years.
Results: Moderately-severe AS was identified in 113 out of 1414 patients (8%). Baseline AVA was 1.1±0.1 cm ² , peak velocity 3.7±0.2 m/s, MG 32.7±4.8 mm Hg and aortic valve calcium volume 588 (364, 815) mm ³ . Valve haemodynamics improved following TAVR (AVA 2.5±0.7 cm ² , peak velocity 1.9±0.5 m/s and MG 8.4±4.8 mm Hg; p<0.001 for all) and SAVR (AVA 2.0±0.6 cm ² , peak velocity 2.1±0.4 m/s and MG 10.0±3.4 mm Hg; p<0.001 for all). At 24 months, the rates of death or disabling stroke were similar (TAVR 7.7% vs SAVR 6.5%; p=0.82). Kansas City Cardiomyopathy Questionnaire overall summary score assessing quality of life improved from baseline to 30 days after TAVR (67.0±20.6 to 89.3±13.4; p<0.001) and SAVR (67.5±19.6 to 78.3±22.3; p=0.001).
Conclusions: In symptomatic patients with moderately-severe AS, AVR appears to be beneficial. Determination of the clinical and haemodynamic profile of patients who can benefit from earlier isolated AVR needs further investigation in randomised clinical trials.
Competing Interests: Competing interests: SI supports the echocardiographic core laboratory for Medtronic trials. RL has received research grants from Medtronic, Boston Scientific and Abbott Vascular. VTN has nothing to disclose. JKF has received grant support/research contracts and consultant fees/honoraria/speakers’ bureau fees from Edwards Lifesciences and Medtronic. MJR has received fees to his institution from Medtronic for consulting and providing educational services. SHL has received research grants from Abbott and Medtronic. AHM serves as a consultant and has received honoraria from Edwards Lifesciences, Medtronic, Japanese Organisation for Medical Device Development and Z-Medica. HG serves as a consultant for Abbott, Bard, Edwards Lifesciences and Medtronic. TB reports fees for consulting and proctoring from Medtronic. DL has nothing to disclose. JoH has nothing to disclose. AC serves as a proctor for Medtronic. BJ has nothing to disclose. GA is a consultant and serves as a proctor and is on the advisory board of Medtronic and is a consultant for Abbott Vascular. MM has nothing to disclose. JiH is an employee and shareholder of Medtronic. JKO is the director of the echocardiographic core laboratory for Medtronic trials and a consultant for Medtronic. He also receives research grant from REDNVIA for EVOID AS trial.
(© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)