This review evaluates extended follow-up data (6–10 years) from pivotal TAVI vs. SAVR trials (Evolut Low Risk, PARTNER 3, PARTNER 2A, UK-TAVI) and meta-analyses to assess valve durability, late adverse events, and reintervention burden in low- and intermediate-risk patients with severe aortic stenosis.
Evolut Low Risk (6–7 yr) showed no significant difference in death or disabling stroke, but signals of later mortality accrual, more MI events, and higher aortic valve reintervention with TAVI emerged; PARTNER 2A (10 yr) showed lower survival and higher reintervention rates with TAVI vs. SAVR in intermediate-risk patients; PARTNER 3 (7 yr) results were limited by methodological concerns.
PARTNER 3 7-year data are constrained by non-prespecified hierarchical analysis, heterogeneous endpoint construction, incomplete follow-up, and post hoc vital-status ascertainment. Most pivotal trials underrepresent younger patients and anatomically complex cases. Long-term data beyond 10 years remain unavailable.
For younger, low-risk patients with severe aortic stenosis, clinicians should exercise caution before defaulting to TAVI, explicitly discussing valve durability, reintervention options, and lifetime management within a structured Heart Team framework. SAVR may offer more durable outcomes at 10 years, particularly in intermediate-risk patients.
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