New findings from the PARTNER 3 trial suggest that transcatheter aortic valve replacement (TAVR) using the SAPIEN 3 valve offers comparable and stable valve performance at 5 years compared to surgery, with added benefits in heart function for low-risk patients with severe symptomatic aortic stenosis. The findings were published in the JACC: Cardiovascular Imaging.

The study followed 1,000 patients who were randomly assigned to undergo either TAVR or open-heart surgery. Echocardiograms were performed at baseline, 30 days, 1 year, and then annually for 5 years. Researchers assessed valve performance and heart function and monitored major outcomes, including death, stroke, or hospitalization.

At 5 years, mild or greater aortic regurgitation was more common after TAVR than surgery (24.5% vs. 6.3%), although moderate or severe leakage remained low in both groups. TAVR patients had slightly higher transaortic gradients (12.8 vs. 11.7 mmHg) but also showed better measures of heart performance, including a higher stroke volume index (44.6 vs. 41.1), improved right heart function (tricuspid annular plane systolic excursion), and better right ventricular-to-pulmonary artery coupling.

Fewer TAVR patients had signs of low blood flow from the heart or elevated stress on the heart. Specific valve-related findings at 30 days, such as aortic regurgitation or valve mismatch, did not predict long-term outcomes. However, poor right heart performance and high heart stress levels at 30 days were linked to a higher risk of major events over 5 years.