Abstract Body (Do not enter title and authors here): Background
TAVR and SAVR are key treatments for aortic stenosis, but data comparing outcomes in patients with HFpEF remain limited. This study assessed short- and long-term outcomes of both procedures in this population.
Methods:
From January 2012 to December 2022, we conducted a TriNetX retrospective cohort study of adults (≥18 y) with non-rheumatic aortic stenosis and HFpEF undergoing first-time TAVR or SAVR, excluding those with congenital valve malformations, prior prostheses, aortic insufficiency, stage 4–5 CKD/dialysis, HFrEF, or cross-exposure, and assessed 1-, 6-, 12-, and 24-month outcomes in propensity-score-matched cohorts.
Results
In matched cohorts (n=754; mean age 75.3 vs 68.4 y; 53.1% vs 60.0% male), TAVR reduced 1-month MACE (RR 0.678; p = 0.048), AF (0.502; p < 0.001), major bleeding (0.226; p < 0.001), respiratory failure (0.561; p = 0.003), endocarditis (0.305; p < 0.001), hospitalizations (0.523; p < 0.001) and AKI (0.400; p < 0.001), but increased LBBB (2.367; p < 0.001) and pacemaker/ICD implantation (1.472; p = 0.022). At 6 months these reductions in AF (0.599; p < 0.001), major bleeding (0.412; p < 0.001), endocarditis (0.469; p = 0.002), hospitalization (0.642; p < 0.001) and AKI (0.524; p < 0.001) persisted alongside continued increases in LBBB (2.879; p < 0.001) and pacemaker/ICD insertion (1.667; p = 0.001). By 1 year TAVR maintained lower AF (0.640; p < 0.001), major bleeding (0.485; p < 0.001), cardiogenic shock (0.455; p = 0.032), endocarditis (0.621; p = 0.019), hospitalization (0.746; p < 0.001) and AKI (0.713; p = 0.012), yet exhibited higher ventricular tachycardia (1.737; p = 0.048), LBBB (2.714; p < 0.001) and pacemaker/ICD insertion (1.762; p < 0.001). By 2 years the benefits in AF (0.688; p < 0.001), cardiogenic shock (0.435; p = 0.022) and major bleeding (0.627; p < 0.001) remained, but TAVR showed increased LBBB (2.364; p < 0.001), ventricular tachycardia (2.136; p = 0.002), TIA (1.692; p = 0.001), MACE (1.349; p = 0.004), mortality (1.868; p = 0.001) and acute heart failure (1.703; p = 0.007), with no AKI benefit (0.918; p = 0.451).
Conclusion
TAVR conferred early benefits—lower rates of atrial fibrillation, major bleeding, and AKI—compared with SAVR, and most persisted through one year. By two years, however, TAVR carried higher risks of conduction disturbances, serious arrhythmias, transient ischemic attacks, acute heart failure, and mortality.