Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients
N Engl J Med, 2019 · Multicenter, randomized, open-label trial
Clinical question
Is TAVR non-inferior or superior to surgical aortic-valve replacement in patients with severe aortic stenosis at low surgical risk?
What the trial found
TAVR demonstrated lower 1-year rates of death, stroke, and rehospitalization compared to SAVR across the surgical risk spectrum.
Current guideline position
Class 1 recommendation in ACC/AHA and ESC guidelines for patients with severe symptomatic AS based on age, anatomy, and surgical risk.
Clinical interpretation
Solidifies TAVR as an established therapeutic alternative to open surgery in critical AS, including emergent transcatheter rescue procedures in hemodynamic instability.
Critical AS, acute AR/MR mechanics, prosthetic valve emergencies, and infective endocarditis with multidisciplinary surgical triggers.
Primary pump failure, SCAI staging (A–E), PAC hemodynamics (CPO, PAPi), inotrope selection, emergent revascularization, and mechanical circulatory support.