Long-term age-stratified outcomes after surgical and transcatheter aortic valve replacement: a Dutch cohort study

BACKGROUND: While randomised trials have shown that surgical and transcutaneous aortic valve replacement/implantation (SAVR/TAVI) have similar short- to mid-term outcomes, long-term outcome data are scarce. Additionally, no large-scale long-term follow-up data from Dutch databases and TAVI centres have been reported to inform national guidelines.

METHODS: We retrospectively analysed baseline characteristics, 5‑year mortality and re-intervention rates of patients undergoing isolated SAVR or TAVI, stratified by age (65-75, 75-80 and > 80 years old) in the Netherlands Heart Registry.

RESULTS: From 2013 through 2021, 7879 SAVR patients (median age: 73.0 years; interquartile range (IQR): 69.0-77.0; 43.7% female) and 14,461 TAVI patients (median age: 81.0 years; IQR: 77.0-84.0; 49.9% female) were treated in the Netherlands. Patients undergoing TAVI more frequently had chronic obstructive pulmonary disease, diabetes, atrial fibrillation, dialysis, poor mobility, previous stroke, unstable angina and recent myocardial infarction compared with SAVR patients. This higher comorbidity rate in TAVI was observed across all age groups. After 5‑year follow-up, mortality rates were higher after TAVI compared with SAVR (35.5% vs 13.0%; p < 0.001). This difference decreased with increasing age (p for interaction < 0.001). While the aortic re-intervention rate was low in both cohorts, it was higher after SAVR than TAVI (1.9% vs 0.9%; p < 0.001).

CONCLUSION: Demographics of patients undergoing SAVR versus TAVI in the Netherlands differed substantially. TAVI patients were older and had more comorbidities than SAVR patients, across all age groups. Mortality rates were highest after TAVI, while aortic re-intervention was more common after SAVR. These findings reflect differences in baseline patient characteristics and current daily practice in decision-making by the Heart Teams.