National Midterm Outcomes of Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve Replacement

Abstract

Background: This study compared the early and midterm outcomes of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in a real-world entire population in Korea. Methods: During 5 years from June 2015 to May 2019, 1468 patients underwent primary isolated transfemoral TAVI and 3897 patients underwent primary isolated SAVR in Korea. Early and midterm clinical outcomes were compared between the groups, and propensity score-matched analysis was also performed to balance between the groups. Subgroup analyses were performed by dividing the overall cohort into 6 age-subgroups of <65, 65 to 69, 70 to 74, 75 to 79, 80 to 84, and ≥85 years. Follow-up was 100% complete. Median follow-up duration was 2.5 years in the TAVI group and 3.0 years in the SAVR group. Results: There was no difference in periprocedural mortality between the groups in the overall cohort (3.2% in TAVI vs 3.5% in SAVR, P =.66), whereas SAVR demonstrated higher periprocedural mortality in the matched cohort (2.9% in TAVI vs 5.6% in SAVR, P =.003). Cumulative incidence of all-cause mortality was not significantly different between TAVI and SAVR in the matched cohort (hazard ratio, 0.96; 95% CI, 0.79-1.16; P =.64), and was also not significantly different in every matched age-subgroup. Other midterm clinical outcomes, including stroke, endocarditis, and reintervention, were comparable between the groups, whereas the cumulative incidence of permanent pacemaker implantation was significantly higher in TAVI. Conclusions: TAVI and SAVR demonstrated comparable midterm survival in the real-world entire population from 2015 to 2019 in Korea. Comparable midterm survival was also demonstrated between all age-subgroups. © 2025