A major international study has found that two of the most common treatments for severe aortic valve disease provide similarly strong long-term results, giving patients and doctors greater confidence when choosing between them.
The research, published in JAMA Cardiology, followed patients for seven years and found that both transcatheter aortic valve replacement (TAVR) and traditional open-heart surgery remained highly effective.
However, researchers also discovered that blood clots on replacement valves were more common after TAVR, highlighting the need for careful follow-up.
Heart valve disease affects more than 28 million people worldwide and becomes more common with age.
The heart contains four valves that keep blood flowing in the correct direction. When one of these valves becomes damaged, the heart has to work much harder.
One of the most common problems is aortic stenosis, in which the aortic valve becomes stiff and narrow, making it difficult for blood to leave the heart. Without treatment, severe aortic stenosis can lead to heart failure and death.
Doctors can replace the damaged valve using two main approaches. Surgical aortic valve replacement, or SAVR, requires open-heart surgery.
TAVR is much less invasive because doctors insert a replacement valve through a blood vessel, usually in the leg, and guide it into the heart. TAVR was first developed for patients who were too sick for surgery, but its use has steadily expanded to younger and healthier patients. This raised an important question: will these less invasive valves last just as long?
To answer this, researchers conducted the PARTNER 3 trial. The study included 1,000 low-risk patients who were healthy enough to undergo surgery.
Participants were randomly assigned to receive either the SAPIEN 3 TAVR valve or a surgically implanted biological valve. The team monitored patients with regular heart ultrasound scans over seven years.
The results were encouraging. Valve wear and tear occurred in only 7.3% of TAVR patients and 7.6% of surgery patients. Valve failure was also very similar, affecting 6.9% and 7.5% of patients respectively.
Around 6% of TAVR patients and 5.5% of surgery patients eventually required another valve procedure. By the end of the study, roughly three-quarters of patients in both groups were still alive with a functioning replacement valve.
The biggest difference involved valve thrombosis. Blood clots developed in 5.2% of TAVR patients compared with just 0.9% of those who had surgery. Although these events were uncommon, the researchers recommend monitoring TAVR patients so clots can be detected and treated early.
Overall, the study suggests that both treatments provide excellent long-term durability for carefully selected low-risk patients. TAVR offers the advantage of avoiding open-heart surgery while delivering similar valve performance over seven years.
However, patients and doctors should also consider the slightly higher risk of valve thrombosis.
Longer follow-up beyond seven years will be important, especially as younger patients may rely on these replacement valves for decades. The findings strengthen confidence in TAVR while reminding clinicians that careful long-term monitoring remains essential.
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