Overview
Prosthetic aortic valve stenosis and regurgitation refer to complications that can arise following aortic valve replacement, including issues such as paravalvular leak 1. The choice between surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI), or between mechanical, bioprosthetic, and Ross procedure valves, impacts long-term outcomes and potential complications 12.Management
For initial aortic valve replacement in low-risk patients, transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) show no significant difference in all-cause mortality or the composite of all-cause mortality or disabling stroke at 5 years 1.
TAVI is associated with an increased risk of mild or greater paravalvular leak and permanent pacemaker implantation compared to SAVR 1.
TAVI is associated with a decreased risk of postprocedural atrial fibrillation compared to SAVR 1.
The Ross procedure is associated with significantly lower all-cause mortality compared to mechanical aortic valve replacement (M-AVR) 2.Special Populations
In low-risk cohorts undergoing aortic valve replacement, TAVI and SAVR demonstrate similar 5-year mortality outcomes 1.
The Ross procedure appears to restore normal survival in young and middle-aged adults with aortic valve disease 2.Key Recommendations
For low-risk patients requiring aortic valve replacement, TAVI and SAVR demonstrate comparable 5-year outcomes regarding all-cause mortality and the composite of all-cause mortality or disabling stroke 1. (Evidence: Strong)
TAVI is associated with a higher risk of mild or greater paravalvular leak and permanent pacemaker implantation compared to SAVR 1. (Evidence: Strong)
The Ross procedure should be considered in young and middle-aged adults, as it is associated with lower all-cause mortality compared to mechanical aortic valve replacement 2. (Evidence: Strong)References
1 Doenst T, Gregg AC, Kirov H, Di Franco A, Caldonazo T, Rahouma M et al.. Surgical versus transcatheter treatment of aortic valve stenosis-a meta-analysis of low-risk randomized trials with completed 5-year follow-up. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2025. link
2 Yokoyama Y, Kuno T, Toyoda N, Fujisaki T, Takagi H, Itagaki S et al.. Ross Procedure Versus Mechanical Versus Bioprosthetic Aortic Valve Replacement: A Network Meta-Analysis. Journal of the American Heart Association 2023. link