Seven-Year Health Outcomes After TAVR Versus SAVR in Low-Risk Aortic Stenosis Patients: Insights from the PARTNER 3 Trial

Highlight

• Both transcatheter (TAVR) and surgical aortic valve replacement (SAVR) significantly improve health status in low-risk aortic stenosis patients, sustained up to 7 years.
• TAVR leads to significantly faster early recovery in quality of life at 1 month compared to SAVR, with benefits persisting modestly up to 2 years.
• From years 3 to 7, patient-reported health status outcomes converge, showing no significant differences between TAVR and SAVR groups.
• About 60% of patients in either group maintain excellent health status at 7 years, emphasizing long-term durability of both interventions.

Study Background and Disease Burden

Severe aortic stenosis (AS) is a progressive valvular heart disease characterized by valve narrowing that impedes blood flow from the left ventricle, causing symptoms such as exertional dyspnea, chest pain, and syncope. If left untreated, it portends high morbidity and mortality. Surgical aortic valve replacement (SAVR) has been the definitive therapy for decades, especially in varying risk groups. More recently, transcatheter aortic valve replacement (TAVR) emerged as a less invasive alternative, initially reserved for high-risk or inoperable patients but increasingly adopted for patients with low surgical risk, driven by advances in device technology and procedural expertise.

Symptomatic low-risk patients with severe AS face a choice between these treatment modalities. While early procedural outcomes and short-term recovery have been compared extensively, evidence on long-term patient-centered health status outcomes—including quality of life and functional status—remains limited. Understanding sustained health benefits, recovery trajectories, and patient-perceived outcomes is crucial to inform individualized treatment decisions and guideline recommendations.

Study Design

The PARTNER 3 trial was a prospective, randomized controlled study evaluating the safety and effectiveness of TAVR with a balloon-expandable valve compared to SAVR in patients with symptomatic severe aortic stenosis at low surgical risk. Low risk was defined by a mean Society of Thoracic Surgeons-Predicted Risk of Mortality (STS-PROM) score of approximately 1.9%. The trial enrolled 1,000 patients randomized 1:1 to TAVR or SAVR, with 943 patients included in the analytic cohort who had baseline health status assessments and underwent their assigned procedure (494 TAVR, 449 SAVR).

Patient health status was assessed with validated instruments: the Kansas City Cardiomyopathy Questionnaire (KCCQ), a disease-specific measure of symptoms, physical function, and quality of life scored 0–100, and the generic Short Form-36 Health Survey (SF-36). Measurements were conducted at baseline, 1 month, 6 months, and then annually up to 7 years post-procedure. The primary analytic focus was on the KCCQ-overall summary (KCCQ-OS) score.

Mixed effects models for repeated measures adjusted for baseline values were used to compare the trajectory of health status between TAVR and SAVR groups over the 7-year follow-up period. A composite “excellent outcome” was defined as being alive with KCCQ-OS ≥75 and no decline ≥10 points from baseline at 7 years.

Key Findings

Both TAVR and SAVR resulted in rapid and sustained improvements in patients’ health status compared to baseline, persisting throughout the 7-year follow-up period. Specifically, the mean baseline KCCQ-OS score was 70.9 ± 20.5, reflecting a moderate symptomatic burden.

At 1 month, patients undergoing TAVR experienced a markedly higher KCCQ-OS—on average 16.2 points greater than SAVR (95% CI: 14.3 to 18.1), indicating significantly faster recovery and improvement in symptoms, function, and quality of life shortly after the procedure. This advantage lessened over time but remained modestly favoring TAVR at 2 years (+1.9 points; 95% CI: 0.2 to 3.7).

From year 3 through 7, no statistically significant differences in KCCQ-OS or SF-36 summary scores were detected between the two groups, indicating comparable long-term health status outcomes. At the 7-year mark, roughly 60% of patients in both cohorts met criteria for an excellent outcome—alive with preserved or improved health status.

These results suggest the early health status benefits of TAVR do not compromise long-term outcomes; both treatment modalities offer durable symptomatic relief and quality of life improvement for low-risk patients.

Additional Insights

– Both groups demonstrated sustained physical and mental health benefits as measured by SF-36 metrics.
– The cohort was primarily male (69.2%) with a mean age of 73.5 years, representative of a typical contemporary low-risk AS population.
– Safety outcomes and mortality data, although not detailed here, have been reported previously in the PARTNER 3 trial, generally supporting the noninferiority or superiority of TAVR in selected low-risk patients.

Expert Commentary

The PARTNER 3 seven-year health status data add valuable insight into long-term patient-centered outcomes after aortic valve replacement in low-risk patients with severe AS. The initial substantial advantages of TAVR in rapid recovery align well with the less invasive nature of the procedure. However, the eventual convergence of health status scores highlights that SAVR remains an excellent treatment option with durable outcomes.

While early procedural data and cost considerations often favor TAVR, clinical decisions must consider individual patient anatomy, comorbidities, valve durability, and patient preferences. Long-term data on valve performance and potential late complications such as valve thrombosis or need for repeat intervention are also critical and warrant ongoing surveillance.

Study limitations include that the trial population was selected for low surgical risk with an average STS-PROM <2%, and results may not extrapolate to intermediate or high-risk groups. Additionally, as the study used the balloon-expandable valve platform, outcomes may vary with different valve technologies.

Conclusions

In low-surgical risk patients with severe symptomatic aortic stenosis, both transcatheter and surgical aortic valve replacements provide substantial and sustained improvements in patient-reported health status over a seven-year period. TAVR offers the advantage of earlier recovery in quality of life measures, but by 3 years and beyond, health status outcomes are comparable between treatments. These findings support the use of either approach in this population, emphasizing shared decision-making based on patient values and clinical profiles.

Funding and Trial Registration

The study was conducted under the PARTNER 3 trial (NCT02675114) framework. Funding sources and detailed declarations were reported in the original publication.

References

Brener MI, Cohen DJ, Kodali SK, et al. Health Status Outcomes 7 Years After Transcatheter or Surgical Aortic Valve Replacement in Low-Surgical Risk Patients With Aortic Stenosis. J Am Coll Cardiol. 2026 Jul 17; PMID: 42524810.

Leon MB, Smith CR, Mack M, et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2016;374(17):1609-1620.

Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. N Engl J Med. 2019;380(18):1706-1715.

Reardon MJ, van Mieghem NM, Popma JJ, et al. Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2017;376(14):1321-1331.