TAVR in Low-Risk Patients: New Data from the STS/ACC TVT Registry

The latest report from the STS/ACC TVT Registry provides valuable real-world insights into transcatheter aortic valve replacement (TAVR) among low-risk patients in the United States. We now have outcomes from over 108,000 patientsdeemed low risk by heart teams between 2020 and 2024—a key piece missing since FDA approval extended to this population in 2019.

Here's what you should know:

The Study

• 383,030 patients underwent TAVR during the study period.

• 108,407 (28%) were categorized as low risk by the heart team.

• 68,194 met broader study inclusion criteria.

• 42,093 (62% of those) were trial-eligible, closely mirroring pivotal trial entry criteria.

This trial-eligible population allows for a direct comparison with outcomes from PARTNER 3 and Evolut Low Risk.

• Median KCCQ score improvement at 30 days was +23 points.

• Over 88% achieved VARC-3 device success.

• Real-world complication rates were slightly higher than trial benchmarks.

Despite meeting strict trial criteria, real-world 1-year mortality and stroke rates remain higher than reported in trials—possibly due to comorbidity burden and differences in post-TAVR care.

Predictors of Poorer 1-Year Outcomes

Several variables were significantly associated with 1-year mortality and stroke:

• Atrial fibrillation

• Lower baseline KCCQ score

• Nontransfemoral access

• Increasing age

• Female sex (for stroke)

These findings emphasize the importance of preprocedural risk stratification and longitudinal care, even in populations labeled "low risk."

What About Younger Patients?

Only 7% of low-risk patients were 65 years or younger. Their outcomes were generally better, especially with respect to stroke risk, suggesting that younger, low-risk TAVR patients may more closely approximate ideal trial profiles.

Key Takeaways

1. Real-world outcomes for TAVR in low-risk patients are good, but not trial-perfect.

2. One-year adverse events remain higher than in trials, particularly stroke and mortality.

3. Trial eligibility doesn't guarantee trial-level outcomes—baseline health status still matters.

4. Nontransfemoral access remains a red flag for worse outcomes and may warrant surgical AVR in some cases.

5. Baseline quality of life (KCCQ) strongly predicts 1-year survival and symptom recovery.

Final Thoughts

As TAVR continues to expand into lower-risk and younger populations, it’s essential to align patient expectations with real-world data. This registry analysis highlights that procedural success is only part of the story—what happens in the months that follow also matters.

As clinicians and researchers, our focus now should shift to longitudinal care, predictive modeling, and targeted risk mitigation strategies for patients who don’t fit the ideal trial profile—even if they technically qualify.

You can read the full study here: Circulation (2024): https://doi.org/10.1161/CIRCULATIONAHA.124.071838