Comparing TA-TAVR and SAVR in severe aortic regurgitation: outcomes and valve haemodynamics.

There were no statistically significant differences between TA-TAVR and SAVR groups in all-cause mortality, cardiovascular mortality, stroke, heart failure rehospitalisation, permanent pacemaker implantation, or moderate to severe paravalvular leakage at 30 days or 2 years after propensity score matching.

• The primary endpoint was 2-year all-cause mortality.
• After 1:1 propensity score matching, 76 matched pairs were included.
• No statistical differences were found across all primary and secondary clinical endpoints between the two groups.
• All patients in the TAVR group received the J-Valve system via the transapical approach.

Before propensity score matching, LVEF improved significantly in the TA-TAVR group but not in the SAVR group.

• In the TAVR group, LVEF improved from 57% (IQR: 45–63%) to 61% (IQR: 55–65%), p<0.001.
• In the SAVR group, LVEF changed from 61% (IQR: 55–65%) to 62% (IQR: 59–66%), p>0.05, indicating no significant change.
• This comparison was made in the unmatched cohort of 256 TA-TAVR and 113 SAVR patients.

After propensity score matching, LVEF improvement was comparable between the TA-TAVR and SAVR groups.

• LVEF improvement was +4.0% (IQR: -1.5 to 10.0) in the TAVR group versus +2.0% (IQR: -3.0 to 9.5) in the SAVR group.
• The difference was not statistically significant (p=0.430).
• This was assessed by transthoracic echocardiography.

Valve haemodynamics were superior in the TA-TAVR group compared with the SAVR group.

• Haemodynamic superiority in the TAVR group was statistically significant (p<0.001).
• Haemodynamics were assessed by transthoracic echocardiography.
• This finding was noted after propensity score matching.

Regression of left ventricular dimensions was greater in the SAVR group compared with the TA-TAVR group.

• LV dimension regression was assessed by transthoracic echocardiography.
• The SAVR group demonstrated greater reduction in LV dimensions despite comparable LVEF improvement after PSM.
• This finding was observed in the matched cohort of 76 pairs.

The study enrolled 369 patients with severe aortic regurgitation who underwent bioprosthetic aortic valve replacement at a single centre between January 2018 and December 2023.

• Median age of enrolled patients was 68 years, and 26.6% were female.
• Of the total cohort, 256 underwent TA-TAVR and 113 underwent SAVR.
• Propensity score matching yielded 76 matched pairs (1:1 ratio).
• This was a retrospective study design.