Three-year outcomes between TAVR and surgery were closely aligned in low-risk adults with severe aortic stenosis. Published in Circulation, the NOTION-2 trial reported midterm clinical and echocardiographic findings in individuals aged 60 to 75 years with a mean Society of Thoracic Surgeons Predicted Risk of Mortality of 1.2%. A total of 370 participants were randomized 1:1 to TAVR or surgery and followed clinically and with echocardiography for three years.

The composite outcome of death, stroke, or hospitalization related to the procedure, valve, or heart failure occurred in 16.1% of patients who underwent TAVR and in 12.6% of those who underwent surgery. Among individuals with tricuspid aortic stenosis, rates were similar at 14.5% and 14.4%. In bicuspid aortic stenosis, a numerically higher but statistically nonsignificant rate occurred after TAVR compared with surgery (20.4% vs 7.8%).

Valve durability was also comparable. Moderate or greater SVD was recorded in 4.5% of transcatheter bioprostheses and 5.2% of surgical bioprostheses. Bioprosthetic valve failure occurred in 1.6% of TAVR patients and 2.9% of surgical patients.

Overall, the findings show that both TAVR and surgery provide similar midterm clinical outcomes and durable valve performance in carefully selected low-risk adults aged 60 to 75 years with severe aortic stenosis.