Among 300,927 adults undergoing transcatheter aortic valve replacement (TAVR) between 2010 and 2026, cumulative reintervention incidence reached only 2.7% at 10 years, while 30-day major adverse cardiovascular events dropped from 31.8% pre-2017 to 18.6% post-2022 and mortality fell from 3.0% to 1.4%. Critically, redo-TAVR carried lower perioperative risk than surgical explantation, but among hospital survivors, surgical explantation conferred superior long-term survival (HR 0.64; 95% CI 0.44–0.93). Clinically significant valve failure also occurred earlier after TAVR than after surgical bioprosthetic replacement (SAVR), despite TAVR's lower overall reintervention rate.
This is the largest real-world TAVR outcomes dataset published to date, and its findings arrive at a pivotal moment: guidelines are increasingly approving TAVR for younger, lower-risk patients who may live decades with their implant. The survival advantage of surgical explantation over redo-TAVR in matched hospital survivors is a genuinely important signal — suggesting that patients who tolerate reoperation may gain meaningful longevity benefit, a trade-off clinicians and patients in their 50s and 60s must weigh carefully. The earlier onset of clinically significant valve failure post-TAVR versus post-SAVR adds further nuance to durability discussions. Limitations include the retrospective design, reliance on Epic Cosmos EHR data with potential coding inconsistencies, and unmeasured confounders despite propensity matching. As a preprint not yet peer-reviewed, these findings should be considered preliminary until formally vetted. Still, the scale and temporal breadth make this an unusually consequential dataset — closer to paradigm-clarifying than merely incremental.