Evaluating the Efficacy and Outcomes of Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement in Low- to Intermediate-Risk Aortic Regurgitation Patients: A Comprehensive Clinical Comparison.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) has been established as an alternative to surgery for high-risk aortic regurgitation (AR) patients. However, its applicability to low- and intermediate-risk populations remains under investigation. This study evaluates the clinical outcomes, quality of care, and patient-centered implications of TAVR versus surgical aortic valve replacement (SAVR) in this population.

METHODS: Between 2021 and 2024, clinical data were retrospectively analyzed from 70 AR patients at our center, including 37 who underwent TAVR and 33 who received SAVR with bioprosthetic valves. Baseline characteristics, perioperative metrics, and major clinical outcomes were assessed. International registry data (FRANCE-TAVI and ALIGN-AR) were utilized for external validity comparisons.

RESULTS: Baseline characteristics were comparable between groups. TAVR was associated with shorter operation time (p = 0.001), reduced blood use (p < 0.001), and shorter hospital stays (p = 0.021). No 30-day mortality was observed in TAVR, whereas four deaths occurred in the SAVR group (p = 0.029). Conduction abnormalities differed, with complete left bundle branch block (CLBBB) more frequent in TAVR (p = 0.025) and complete right bundle branch block (CRBBB) in SAVR (p = 0.029). Despite its minimally invasive nature, ICU observation time remained similar (p = 0.339) due to perioperative complications. Economic analysis suggests potential cost savings with TAVR in specific scenarios.

CONCLUSION: TAVR offers favorable short-term outcomes for low- to intermediate-risk AR patients, yet challenges in perioperative care require optimization. Long-term studies and multicenter trials are needed to refine patient selection and postprocedural management strategies.