Long-term data from the PARTNER 3 trial show no significant differences in key clinical outcomes at 7 years between transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve replacement (SAVR) for low-risk patients with severe, symptomatic aortic stenosis.¹ This extended follow-up provides crucial insights into the durability and long-term safety of both procedures in this patient population.

The PARTNER 3 trial was a multicentre, randomised controlled trial that enrolled 1000 low-risk patients with severe, symptomatic aortic stenosis. Participants were assigned in a 1:1 ratio to undergo either transfemoral TAVR or SAVR. The first primary endpoint was a nonhierarchical composite of death, stroke, or rehospitalisation related to the procedure, valve, or heart failure. The second primary endpoint was a hierarchical composite of death, disabling stroke, non-disabling stroke, and the number of rehospitalisation days, analysed using a win ratio.

At the 7-year follow-up, the Kaplan–Meier estimate for the incidence of a first primary endpoint event was 34.6% in the TAVR group and 37.2% in the surgery group, showing no significant difference (difference, −2.6 percentage points; 95% CI, −9.0 to 3.7). The win ratio for the second primary endpoint was 1.04 (95% CI, 0.84 to 1.30), also indicating no significant difference between the two groups.

Analysis of the individual components of the primary endpoint revealed similar incidences. The Kaplan–Meier estimates for death were 19.5% with TAVR and 16.8% with surgery. For stroke, the rates were 8.5% and 8.1%, respectively. Rehospitalisation occurred in 20.6% of TAVR patients and 23.5% of surgery patients.

Echocardiographic assessments at 7 years showed comparable haemodynamic performance, with mean aortic-valve gradients of 13.1 mm Hg after TAVR and 12.1 mm Hg after surgery. Furthermore, the rate of bioprosthetic valve failure was similar, occurring in 6.9% of the TAVR group and 7.3% of the surgery group. Patient-reported health outcomes were also comparable between the interventions.

These 7-year findings from the PARTNER 3 trial demonstrate that among low-risk patients with severe aortic stenosis, TAVR and SAVR yield similar results with respect to the primary composite endpoints of death, stroke, and rehospitalisation. The comparable rates of valve failure and haemodynamic performance provide reassurance regarding the longer-term durability of TAVR in this patient cohort, supporting its role as a viable alternative to surgery.

This study was funded by Edwards Lifesciences.

References

1. Leon MB, Mack MJ, Pibarot P, et al. Transcatheter or Surgical Aortic-Valve Replacement in Low-Risk Patients at 7 Years. N Engl J Med. 2025. https://doi.org/10.1056/NEJMoa2509766.

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