Five-year outcome in 18 010 patients from the German Aortic Valve Registry




Take Home Message

The finding from the GARY registry is concerning as it raises the question of what could be done to low- and intermediate-risk patients who had TAVI implanted and now may face shorter life expectancy. A debate that the surgical and medical societies should compulsorily embrace and coordinate their efforts regarding the response to flawed trials and unrealistic guidelines.

Abstract

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Commentary by Walter Gomes, MD PhD

The report of the German Aortic Valve Registry (GARY) (Eur J Cardiothorac Surg. 2021 May 4:ezab216) assessing the long-term outcomes of aortic valve replacement with TAVI and SAVR, disclosed that after propensity score matching, TAVI with early-generation prosthesis was associated with significantly higher 5-year all-cause mortality than SAVR.

Reaffirming earlier data from Italian and French nationwide registries, the GARY registry, the largest ever gathering of patients in this subject, once again demonstrate the superiority of the surgical treatment over TAVI after 5 years. Additionally, the curves for survival probability keep diverging over time, hinting at a longer-term worse prognosis for patients who underwent TAVI procedure.

The finding from the GARY registry is concerning as it raises the question of what could be done to low- and intermediate-risk patients who had TAVI implanted and now may face shorter life expectancy. A debate that the surgical and medical societies should compulsorily embrace and coordinate their efforts regarding the response to flawed trials and unrealistic guidelines.