Selection for Transcatheter Versus Surgical Aortic Valve Replacement and Mid-Term Survival: Results of the Autheartvisit Study 

In this large population-based cohort study, long-term mortality and morbidity were investigated in patients undergoing biological surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) for severe aortic valve stenosis. Individual data from the Austrian Insurance Funds from 2010 through 2020 were analyzed. The primary outcome was all-cause mortality, assessed in the overall and propensity score-matched populations. A total of 18,882 patients underwent SAVR (n = 11,749; 62.2 percent) or TAVR (n = 7,133; 37.8 percent); The median follow-up was 5.8 (95 percent CI 5.7-5.9) years (maximum 12.3 years). The risk of all-cause mortality was higher among TAVR patients: HR 1.5, 95 percent CI 1.4-1.6, P < 0.001; propensity score-matched HR 1.5, 95 percent CI 1.4-1.6, P < 0.001. The estimated median survival was 8.8 years (95 percent CI 8.6-9.1) after SAVR versus 5 years (95 percent CI 4.9-5.2) after TAVR. The estimated 5-year survival probability was 0.66 (95 percent CI0.66-0.68) after SAVR versus 0.40 (95 percent CI0.37-0.44) following TAVR, and 0.69 (0.67-0.70) versus 0.56 (0.54-0.58), respectively, in the matched cohort. There was a survival benefit in patients who underwent SAVR among patients aged 65-75 years and >75 years.