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Changes in the institutional treatment of severe aortic stenosis following the introduction of transcatheter aortic valve implantation

Year: 2026

Type: article

Abstract: Introduction: Transcatheter aortic valve implantation (TAVI) has transformed the treatment of severe aortic stenosis.Aim: To investigate the association of TAVI introduction on institutional volume and characteristics of patients treated for aortic stenosis either by surgical aortic valve replacement (SAVR) or TAVI.Material and methods: A single-centre retrospective observational study of consecutive patients treated only with SAVR (SAVR-only period, 2004(SAVR-only period, -2017) ) and with either SAVR or TAVI (SAVR + TAVI period, 2017-2025).Results: During the SAVR-only period, 1011 patients underwent SAVR, and during the SAVR + TAVI period, 685 patients underwent SAVR and 824 underwent TAVI.The total number of aortic valve interventions increased annually by 9% (95% CI: 1.08-1.10;p < 0.001), while SAVR decreased by 15% during the SAVR + TAVI period (95% CI: 0.82-0.89;p < 0.001).Cumulative 30-day mortality was 2.8% during the SAVR-only period and 1.5% during the SAVR + TAVI period (p = 0.021).Patients undergoing SAVR during the SAVR + TAVI period were younger (68 vs. 70 years; p < 0.001), had a lower Logistic EuroSCORE (4.52 vs. 6.33;p < 0.001) and less often underwent concomitant revascularization (29% vs. 35%; p = 0.013).Patients undergoing TAVI compared to SAVR were older (80 vs. 68 years; p < 0.001), had a higher Logistic EuroSCORE (11.39 vs. 4.52; p < 0.001), and had comparable 30-day mortality (1.0% vs. 2.0%; p = 0.083).The difference in 5-year mortality in favour of SAVR (13.8% vs. 27.4%) was not significant after adjustment for age, sex and Logistic EuroSCORE (HR = 0.794; 95% CI: 0.550-1.147;p = 0.22).Conclusions: Introduction of TAVI was associated with increased institutional volume of aortic valve interventions despite a concomitant decrease in the number of SAVR procedures.TAVI appears to have expanded treatment to previously undertreated high-risk elderly patients while also being used in a sizable proportion of patients who previously underwent SAVR.Key words: aortic stenosis, transcatheter aortic valve implantation, surgical aortic valve replacement. S u m m a r yOur study, which reflects real-world practice, demonstrated a shift in how severe aortic stenosis is treated at the system level after introduction of a transcatheter aortic valve implantation (TAVI) programme.While the volume of treated patients with severe aortic stenosis increased, the number of surgical aortic valve replacement (SAVR) procedures decreased, with patients undergoing SAVR becoming younger, lower risk and less complex.In contrast, TAVI was used predominantly in previously undertreated elderly patients with high or prohibitive surgical risk.Thus, TAVI appears not to have simply replaced SAVR but to have expanded the overall volume of aortic valve interventions and changed the distribution of patients between the two therapies.

Source: Advances in Interventional Cardiology

DOI: 10.5114/aic.2026.164693