Joint Statement from STS and EACTS Regarding Aortic Valve Replacement in Low-Risk Patients

The Society of Thoracic Surgeons (STS) and the European Association of Cardio-Thoracic Surgery (EACTS) published a joint press release regarding aortic valve replacement in low-risk patients. Both associations highlight the value of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) as outstanding therapeutic options for patients with aortic stenosis and acknowledge the important role of TAVI in high-risk or advanced-age patients. 
Furthermore, STS and EACTS welcome randomized controlled trials (RCTs) studying low- and intermediate-risk populations to help inform clinical decision making. Despite the interesting insights of the recently presented and simultaneously published five-year PARTNER 3 and four-year Evolut low-risk trials results, and given the highly selected cohorts and the industry sponsored nature of these trials, both societies consider some equipoise statements as inappropriately weighted. Therefore, STS and EACTS suggest caution in adopting a TAVI-first strategy in low-risk patients, particularly in those patients who differ from the specific cohorts studied in these low-risk trials. Before encouraging a TAVI-first strategy in low-risk patients, more follow-up time from the existing low-risk trials is required. 
Finally, STS and EACTS encourage the investigators from both low-risk trials to publish their results for the isolated SAVR and isolated TAVI arms to allow valve therapy specialists to compare low-risk TAVI all-cause mortality outcomes with the real world analysis of patients undergoing low-risk isolated SAVR in the STS Adult Cardiac Surgery Database (Thourani VH, et al., The Annals of Thoracic Surgery, October 2023). Until this data is available, any statements or conclusions from the PARTNER 3 and Evolut Low Risk trials are still hypothesis-generating and speculative.