The PARTNER 2A RCT compared 10-year clinical and echocardiographic outcomes of balloon-expandable TAVR (SAPIEN XT) vs. surgical aortic valve replacement (SAVR) in 1,910 intermediate-surgical-risk patients with severe symptomatic aortic stenosis, stratified by transfemoral (TF) vs. transapical/transaortic (TA/TAo) access.
All-cause 10-year mortality was 86.1% (TAVR) vs. 82.8% (SAVR; HR 1.13, 95% CI 1.02–1.25; P=0.02). Mortality difference was driven by the TA/TAo cohort (93.2% vs. 85.1%; P<0.01); TF-TAVR and SAVR had similar mortality (83.9% vs. 82.1%; P=0.27). Aortic valve reintervention at 10 years was significantly higher with TAVR (6.3% vs. 1.6%; P<0.001). Mean aortic gradients at 10 years were equivalent (~12.6–12.7 mm Hg).
- Very few patients had echocardiographic data available at 10 years (24 TAVR, 35 SAVR), limiting hemodynamic conclusions. - Reconsent required at 5 years may have introduced attrition bias; ~10% of patients lacked vital status data. - SAPIEN XT is an older-generation device; results may not apply to current TAVR platforms.
For intermediate-risk patients eligible for transfemoral TAVR, 10-year survival is comparable to surgery, supporting continued TF-TAVR use. The higher reintervention rate with TAVR (6.3% vs. 1.6%) should factor into shared decision-making, especially for younger or lower-surgical-risk patients.
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