{ "release_id": "f4600233112e1c27", "id": "cardio:guide-valve-disease-options", "owner": "cardio", "kind": "patient_guide", "slug": "valve-disease-options", "name": "Valve disease: catheter valve or surgery", "aliases": [], "atlases": [ "cardio" ], "summary_plain": "What heart valve disease is, how MedlinePlus and NHLBI describe treating it, what four trials of a catheter valve (TAVR) found, and questions to ask a care team.", "summary_technical": "A static guide to heart valve disease and the choice between a catheter valve and open-heart surgery, written from public health pages, abstracts of seven trial reports and a summary of one 2020 guideline. It gives no advice for one reader.", "editorial_state": "draft", "last_substantive_edit": "2026-10-15", "last_evidence_check": "2026-10-15", "next_review_due": "2027-04-15", "identifiers": [], "navigation": { "cardio": { "system": [ "heart" ], "condition-area": [ "valvular-and-congenital-disease" ] } }, "payload": { "purpose": "preparing_for_care", "audience": "Adults who have a problem with a heart valve, and the people with them", "about": [ "cardio:heart-valve-disease", "cardio:aortic-stenosis", "cardio:tavr", "cardio:surgical-aortic-valve-replacement" ], "reading_grade_target": 10, "scope_note": "Written from two MedlinePlus pages, an NHLBI page, the abstracts of seven trial reports from four trials and one summary of a 2020 guideline. It describes what these sources say and gives no advice for one person. The trial results come from abstracts, not the full papers.", "warning_blocks": [], "sections": [ { "heading": "What heart valve disease is", "statements": [ { "id": "def-1", "text": "MedlinePlus says heart valve disease happens when at least one heart valve does not work well.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, opening section, para 1" } ] }, { "id": "def-reg", "text": "In regurgitation, the flaps of a valve do not close tightly, so blood leaks backward.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, types section, regurgitation" } ] }, { "id": "def-sten", "text": "In stenosis, the flaps become thick, stiff or stuck together, so the valve cannot open all the way.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, types section, stenosis" } ] }, { "id": "def-atr", "text": "In atresia, a valve did not form properly and has no opening that lets blood through.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, types section, atresia" } ] }, { "id": "def-both", "text": "Sometimes a valve can have both regurgitation and stenosis.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, types section, closing sentence" } ] }, { "id": "def-aortic", "text": "Aortic valve stenosis is a common type of stenosis, and it affects the valve that lets blood flow from the heart into the large artery that carries it to the body.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, types section, stenosis, sentence 4" }, { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, types section, stenosis, sentence 5" } ] }, { "id": "def-cause", "text": "Some people are born with heart valve disease, and MedlinePlus says it can also develop over time with age or with certain conditions that affect the heart.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, causes section, sentence 1" }, { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, causes section, sentence 4" } ] }, { "id": "def-age", "text": "MedlinePlus lists older age as one thing that raises the chance of valve disease, because the valves can become thick and stiff with age.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, risk factors section, older age" } ] }, { "id": "def-live", "text": "MedlinePlus says many people live their whole lives with a valve that does not work perfectly and never have any problems.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, symptoms section, sentence 1" } ] }, { "id": "def-worse", "text": "It also says valve disease may get worse slowly over time.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, symptoms section, sentences 2 and 3" } ] }, { "id": "def-sym", "text": "MedlinePlus lists shortness of breath, fatigue, swelling in the feet, ankles, belly or neck veins, chest pain during physical activity, a problem with heart rate or rhythm, and dizziness or fainting among the signs and symptoms that may develop.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, symptoms section, sentences 2 and 3" }, { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, symptoms section, list items 1 to 3" }, { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, symptoms section, list items 4 to 6" } ] }, { "id": "def-work", "text": "Without treatment, MedlinePlus says, the extra workload on the heart can lead to heart failure, stroke, blood clots, and sudden cardiac arrest or death.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, other problems section" } ] } ] }, { "heading": "What MedlinePlus says about treatment", "statements": [ { "id": "tx-1", "text": "MedlinePlus says most heart valve problems can be treated successfully.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, treatments section, para 1" } ] }, { "id": "tx-2", "text": "Treatment can involve medicines to control symptoms and keep the heart pumping well, lifestyle changes for related heart conditions, or surgery that repairs or replaces a valve.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, treatments section, list items 1 and 2" }, { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, treatments section, list item 3" } ] }, { "id": "tx-3", "text": "It says a person may need surgery even without symptoms, because fixing the valve can help prevent future heart problems.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, treatments section, para 2" } ] }, { "id": "tx-4", "text": "It says there are many ways to do heart valve surgery, and that the patient and doctor can decide what is best based on the valve problem and general health.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, treatments section, para 3, sentence 1" }, { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, treatments section, para 3, sentence 2" } ] }, { "id": "tx-5", "text": "Repair surgery has fewer risks than replacement surgery, MedlinePlus says, so repair is preferred when it is possible.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, treatments section, para 3, sentences 3 and 4" } ] }, { "id": "tx-6", "text": "In some cases replacement is necessary, with either a biologic valve made from pig, cow or human tissue or a human-made mechanical valve.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, treatments section, para 4" }, { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, treatments section, replacement valves, biologic, sentence 1" }, { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, treatments section, replacement valves, mechanical, sentence 1" } ] }, { "id": "tx-7", "text": "MedlinePlus says biologic valves tend to wear out after 10 to 15 years, but some may last longer.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, treatments section, replacement valves, biologic, sentence 2" } ] }, { "id": "tx-8", "text": "It says mechanical valves usually do not wear out, but with one, blood thinners are usually needed for the rest of a person's life to prevent blood clots.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, treatments section, replacement valves, mechanical, sentence 1" }, { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, treatments section, replacement valves, mechanical, sentence 2" } ] }, { "id": "tx-9", "text": "It adds that the risk of endocarditis, a heart infection, is higher with a mechanical valve than with a biologic valve.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, treatments section, replacement valves, mechanical, sentence 3" } ] } ] }, { "heading": "Open-heart surgery and catheter valves, as the sources describe them", "statements": [ { "id": "os-1", "text": "MedlinePlus describes open-heart surgery, also called traditional heart surgery, as an operation in which the surgeon cuts the chest open to reach the heart.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartsurgery-2026-10-15", "locator": "Summary, approaches section, open-heart surgery, sentence 1" } ] }, { "id": "os-2", "text": "For open-heart surgery in general, it says medicines are used to stop the heart.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartsurgery-2026-10-15", "locator": "Summary, approaches section, open-heart surgery, sentence 2" } ] }, { "id": "os-2b", "text": "It also says a heart-lung bypass machine keeps oxygen-rich blood pumping through the body during the operation.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartsurgery-2026-10-15", "locator": "Summary, approaches section, open-heart surgery, sentence 3" } ] }, { "id": "os-3", "text": "It treats minimally invasive heart surgery as a separate approach, one that uses small cuts between the ribs.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartsurgery-2026-10-15", "locator": "Summary, approaches section, minimally invasive heart surgery, sentence 1" } ] }, { "id": "os-4", "text": "MedlinePlus says heart surgery in general has risks, as all surgery does, even though the results are often excellent.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartsurgery-2026-10-15", "locator": "Summary, risks section, sentence 1" } ] }, { "id": "os-5", "text": "For heart surgery in general, it lists bleeding, infection, fever and swelling, a problem from anesthesia, arrhythmia (a problem with heart rate or rhythm), damage to the heart, kidneys, liver and lungs, and stroke as risks.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartsurgery-2026-10-15", "locator": "Summary, risks section, list items 1 to 3" }, { "snapshot_id": "cardio:medlineplus-heartsurgery-2026-10-15", "locator": "Summary, risks section, list items 4 to 6" }, { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, symptoms section, list items 4 to 6" } ] }, { "id": "os-6", "text": "It says these risks tend to be higher if the surgery is an emergency.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartsurgery-2026-10-15", "locator": "Summary, risks section, higher-risk list, item 1" } ] }, { "id": "os-6b", "text": "It also says the risks tend to be higher with other medical conditions, including diabetes, kidney diseases, lung diseases and peripheral artery disease.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartsurgery-2026-10-15", "locator": "Summary, risks section, higher-risk list, item 2" } ] }, { "id": "os-7", "text": "NHLBI says a valve can be replaced in open-heart surgery, or by a less invasive procedure that guides a catheter, which is a thin tube, to the heart through a blood vessel.", "cites": [ { "snapshot_id": "cardio:nhlbi-heart-valve-diseases-treatment-2026-10-14", "locator": "Treatment, Heart valve replacement, para 5, sentence 1, part 1" }, { "snapshot_id": "cardio:nhlbi-heart-valve-diseases-treatment-2026-10-14", "locator": "Treatment, Heart valve replacement, para 5, sentence 1, part 2" } ] }, { "id": "os-8", "text": "NHLBI names transcatheter aortic valve replacement, or TAVR, as a common example of a catheter procedure.", "cites": [ { "snapshot_id": "cardio:nhlbi-heart-valve-diseases-treatment-2026-10-14", "locator": "Treatment, Heart valve replacement, para 5, sentence 2" } ] }, { "id": "os-9", "text": "It says TAVR is used to replace the aortic valve in aortic stenosis, and it also uses the name TAVI for the same procedure.", "cites": [ { "snapshot_id": "cardio:nhlbi-heart-valve-diseases-treatment-2026-10-14", "locator": "Treatment, Heart valve replacement, para 5, sentence 3" } ] }, { "id": "os-10", "text": "NHLBI lists stroke, blood clots, injury to the heart or kidneys, and bleeding or damage where a catheter went in among the risks of valve replacement.", "cites": [ { "snapshot_id": "cardio:nhlbi-heart-valve-diseases-treatment-2026-10-14", "locator": "Treatment, Heart valve replacement, para 7, sentence 1, part 1" }, { "snapshot_id": "cardio:nhlbi-heart-valve-diseases-treatment-2026-10-14", "locator": "Treatment, Heart valve replacement, para 7, sentence 1, part 2" } ] }, { "id": "os-11", "text": "It adds that the new valve sometimes leaks when it is a poor fit.", "cites": [ { "snapshot_id": "cardio:nhlbi-heart-valve-diseases-treatment-2026-10-14", "locator": "Treatment, Heart valve replacement, para 7, sentence 2" } ] }, { "id": "os-12", "text": "NHLBI says the choice between a mechanical and a biological valve is made with the patient's doctors and depends on the person's age, other medical conditions and risk factors.", "cites": [ { "snapshot_id": "cardio:nhlbi-heart-valve-diseases-treatment-2026-10-14", "locator": "Treatment, Heart valve replacement, para 2, sentence 2, part 1" }, { "snapshot_id": "cardio:nhlbi-heart-valve-diseases-treatment-2026-10-14", "locator": "Treatment, Heart valve replacement, para 2, sentence 2, part 2" } ] }, { "id": "os-14", "text": "NHLBI lists inflating a balloon to stretch a valve opening as one way to repair a valve, and says valvuloplasty can use a balloon.", "cites": [ { "snapshot_id": "cardio:nhlbi-heart-valve-diseases-treatment-2026-10-14", "locator": "Treatment, Heart valve repair, list item 2, sentence 1" }, { "snapshot_id": "cardio:nhlbi-heart-valve-diseases-treatment-2026-10-14", "locator": "Treatment, Heart valve repair, list item 2, sentence 2" } ] }, { "id": "os-13", "text": "NHLBI says some medicines and regular medical visits remain part of care after a valve is repaired or replaced.", "cites": [ { "snapshot_id": "cardio:nhlbi-heart-valve-diseases-treatment-2026-10-14", "locator": "Treatment, opening section, para 2, sentence 3" } ] } ] }, { "heading": "Four trials of a catheter valve", "statements": [ { "id": "fund-1", "text": "According to their abstracts, each of the four trials described in this guide was funded by a company, Edwards Lifesciences or Medtronic.", "cites": [ { "claim": "cardio:claim-partner-3-primary" }, { "claim": "cardio:claim-evolut-low-risk-primary" }, { "claim": "cardio:claim-tavr-2010-mortality" }, { "claim": "cardio:claim-early-tavr-primary" } ] }, { "id": "route-1", "text": "In PARTNER 3, the 2010 trial and EARLY TAVR, the valve was placed through the femoral artery, a route the abstracts call transfemoral.", "cites": [ { "claim": "cardio:claim-partner-3-primary" }, { "claim": "cardio:claim-tavr-2010-mortality" }, { "claim": "cardio:claim-early-tavr-primary" } ] }, { "id": "valves-1", "text": "PARTNER 3 and the Evolut Low Risk trial tested different TAVR valves, and the claim cards say neither result extends to other valves or to people at higher surgical risk.", "cites": [ { "claim": "cardio:claim-partner-3-primary" }, { "claim": "cardio:claim-evolut-low-risk-primary" } ] } ] }, { "heading": "PARTNER 3: TAVR against surgery in people at low surgical risk, up to 1 year", "statements": [ { "id": "p3-1", "text": "In PARTNER 3, 1000 people with severe aortic stenosis and low surgical risk were randomly assigned to TAVR or to surgery.", "cites": [ { "claim": "cardio:claim-partner-3-primary" } ] }, { "id": "p3-risk", "text": "In PARTNER 3, the average age was 73 and the average surgical risk score was 1.9%.", "cites": [ { "snapshot_id": "cardio:pubmed-30883058-2026-10-14", "locator": "Abstract, RESULTS, sentence 2, fragment 1 of 2" } ] }, { "id": "p3-risk2", "text": "On that scale, higher scores mean a greater risk of death within 30 days after the procedure.", "cites": [ { "snapshot_id": "cardio:pubmed-30883058-2026-10-14", "locator": "Abstract, RESULTS, sentence 2, fragment 1 of 2" }, { "snapshot_id": "cardio:pubmed-30883058-2026-10-14", "locator": "Abstract, RESULTS, sentence 2, fragment 2 of 2" } ] }, { "id": "p3-2", "text": "At 1 year, the estimated rate of death, stroke or being in hospital again was 8.5% with TAVR and 15.1% with surgery.", "cites": [ { "claim": "cardio:claim-partner-3-primary" } ] }, { "id": "p3-3", "text": "At 1 year, the authors concluded that this combined rate was significantly lower with TAVR than with surgery in the as-treated population.", "cites": [ { "claim": "cardio:claim-partner-3-primary" } ] }, { "id": "af-1", "text": "MedlinePlus counts atrial fibrillation among the most common arrhythmias, which are problems with the heartbeat's rate or rhythm.", "cites": [ { "snapshot_id": "cardio:medlineplus-atrial-fibrillation-2026-10-14", "locator": "Summary, What is atrial fibrillation (AFib)?, sentence 1" }, { "snapshot_id": "cardio:medlineplus-heartvalvediseases-2026-10-14", "locator": "Summary, symptoms section, list items 4 to 6" } ] }, { "id": "p3-4", "text": "At 30 days in PARTNER 3, TAVR had lower rates of stroke, of death or stroke, and of new atrial fibrillation than surgery.", "cites": [ { "claim": "cardio:claim-partner-3-primary" } ] }, { "id": "p3-5", "text": "The abstract also reports a shorter hospital stay for the procedure with TAVR.", "cites": [ { "claim": "cardio:claim-partner-3-primary" } ] }, { "id": "p3-6", "text": "The abstract reports no significant differences between TAVR and surgery in major vascular complications, new permanent pacemakers, or moderate or severe leaks around the valve.", "cites": [ { "claim": "cardio:claim-partner-3-primary" } ] } ] }, { "heading": "PARTNER 3 at 5 and 7 years", "statements": [ { "id": "p3l-pop", "text": "The 5-year and 7-year reports are from the same randomized PARTNER 3 trial, in low-risk people with severe, symptomatic aortic stenosis.", "cites": [ { "snapshot_id": "cardio:pubmed-37874020-2026-10-15", "locator": "Abstract, METHODS, sentence 1" }, { "snapshot_id": "cardio:pubmed-41144631-2026-10-15", "locator": "Abstract, METHODS, sentence 1" } ] }, { "id": "p5-1", "text": "At 5 years, an estimated 22.8% of the TAVR group and 27.2% of the surgery group had a first primary event, which was death, stroke, or rehospitalization related to the valve, the procedure or heart failure.", "cites": [ { "snapshot_id": "cardio:pubmed-37874020-2026-10-15", "locator": "Abstract, METHODS, sentence 2" }, { "snapshot_id": "cardio:pubmed-37874020-2026-10-15", "locator": "Abstract, RESULTS, sentence 2" } ] }, { "id": "p5-2", "text": "The authors found no significant difference between the groups in either of the two primary combined outcomes at 5 years.", "cites": [ { "snapshot_id": "cardio:pubmed-37874020-2026-10-15", "locator": "Abstract, CONCLUSIONS, sentence 1, part" } ] }, { "id": "p5-3", "text": "The 5-year estimates for the parts of the first outcome were death 10.0% with TAVR and 8.2% with surgery, stroke 5.8% and 6.4%, and rehospitalization 13.7% and 17.4%.", "cites": [ { "snapshot_id": "cardio:pubmed-37874020-2026-10-15", "locator": "Abstract, RESULTS, sentence 4, lead-in" }, { "snapshot_id": "cardio:pubmed-37874020-2026-10-15", "locator": "Abstract, RESULTS, sentence 4, components" } ] }, { "id": "p5-4", "text": "At 5 years, bioprosthetic valve failure occurred in 3.3% of the TAVR group and 3.8% of the surgery group.", "cites": [ { "snapshot_id": "cardio:pubmed-37874020-2026-10-15", "locator": "Abstract, RESULTS, sentence 6" } ] }, { "id": "p7-1", "text": "At 7 years, an estimated 34.6% of the TAVR group and 37.2% of the surgery group had the same kind of combined outcome of death, stroke or rehospitalization.", "cites": [ { "snapshot_id": "cardio:pubmed-41144631-2026-10-15", "locator": "Abstract, METHODS, sentence 2" }, { "snapshot_id": "cardio:pubmed-41144631-2026-10-15", "locator": "Abstract, RESULTS, sentence 2, part 1" } ] }, { "id": "p7-2", "text": "The 7-year abstract reports no significant differences in either primary combined outcome.", "cites": [ { "snapshot_id": "cardio:pubmed-41144631-2026-10-15", "locator": "Abstract, CONCLUSIONS, sentence 1, part" } ] }, { "id": "p7-3", "text": "The 7-year estimates for the parts were death 19.5% with TAVR and 16.8% with surgery, stroke 8.5% and 8.1%, and rehospitalization 20.6% and 23.5%.", "cites": [ { "snapshot_id": "cardio:pubmed-41144631-2026-10-15", "locator": "Abstract, RESULTS, sentence 4, lead-in" }, { "snapshot_id": "cardio:pubmed-41144631-2026-10-15", "locator": "Abstract, RESULTS, sentence 4, components" } ] }, { "id": "p7-4", "text": "At 7 years, the percentage of bioprosthetic valves that failed was 6.9% in the TAVR group and 7.5% in the surgery group.", "cites": [ { "snapshot_id": "cardio:pubmed-41144631-2026-10-15", "locator": "Abstract, RESULTS, sentence 6" } ] } ] }, { "heading": "Evolut Low Risk: TAVR against surgery at 24 months", "statements": [ { "id": "el-1", "text": "In the Evolut Low Risk trial, 1468 people with severe aortic stenosis and low surgical risk were randomly assigned to TAVR or to surgery.", "cites": [ { "claim": "cardio:claim-evolut-low-risk-primary" } ] }, { "id": "el-age", "text": "The mean age in the Evolut Low Risk trial was 74 years.", "cites": [ { "snapshot_id": "cardio:pubmed-30883053-2026-10-14", "locator": "Abstract, RESULTS, sentence 2" } ] }, { "id": "el-2", "text": "At 24 months, a statistical model estimated the rate of death or disabling stroke at 5.3% with TAVR and 6.7% with surgery, from an analysis done when 850 people had been followed for 12 months.", "cites": [ { "claim": "cardio:claim-evolut-low-risk-primary" } ] }, { "id": "el-3", "text": "The authors concluded that TAVR was noninferior to surgery on this measure, which tests whether it was no worse and is not a finding that it lowered events.", "cites": [ { "claim": "cardio:claim-evolut-low-risk-primary" } ] }, { "id": "el-3b", "text": "The abstract reports no test of whether TAVR was better than surgery.", "cites": [ { "claim": "cardio:claim-evolut-low-risk-primary" } ] }, { "id": "el-4", "text": "At 30 days in that trial, TAVR had less disabling stroke (0.5% against 1.7%), fewer bleeding complications (2.4% against 7.5%), less sudden (acute) kidney injury (0.9% against 2.8%) and less atrial fibrillation (7.7% against 35.4%) than surgery.", "cites": [ { "claim": "cardio:claim-evolut-low-risk-30-day" } ] }, { "id": "el-5", "text": "At 30 days it also had more moderate or severe aortic regurgitation, which is blood leaking back through the aortic valve (3.5% against 0.5%), and more pacemaker implants (17.4% against 6.1%).", "cites": [ { "claim": "cardio:claim-evolut-low-risk-30-day" } ] }, { "id": "el-6", "text": "The abstract gives these 30-day percentages without counts, intervals or tests.", "cites": [ { "claim": "cardio:claim-evolut-low-risk-30-day" } ] } ] }, { "heading": "Evolut Low Risk at 5 years", "statements": [ { "id": "e5-pop", "text": "The 5-year report covers 1,414 people, 730 in the TAVR group and 684 in the surgery group.", "cites": [ { "snapshot_id": "cardio:pubmed-40158212-2026-10-15", "locator": "Abstract, METHODS, sentence 1" }, { "snapshot_id": "cardio:pubmed-40158212-2026-10-15", "locator": "Abstract, RESULTS, sentence 1" } ] }, { "id": "e5-1", "text": "At 5 years, an estimated 15.5% of the TAVR group and 16.4% of the surgery group had died from any cause or had a disabling stroke.", "cites": [ { "snapshot_id": "cardio:pubmed-40158212-2026-10-15", "locator": "Abstract, RESULTS, sentence 3, part 1" }, { "snapshot_id": "cardio:pubmed-40158212-2026-10-15", "locator": "Abstract, RESULTS, sentence 3, part 2" } ] }, { "id": "e5-2", "text": "The 5-year estimates for the parts were death from any cause 13.5% with TAVR and 14.9% with surgery, and disabling stroke 3.6% and 4.0%.", "cites": [ { "snapshot_id": "cardio:pubmed-40158212-2026-10-15", "locator": "Abstract, RESULTS, sentence 4, parts" }, { "snapshot_id": "cardio:pubmed-40158212-2026-10-15", "locator": "Abstract, RESULTS, sentence 4, part 2" } ] }, { "id": "e5-3", "text": "Over 5 years, the rate of valve reintervention was 3.3% with TAVR and 2.5% with surgery.", "cites": [ { "snapshot_id": "cardio:pubmed-40158212-2026-10-15", "locator": "Abstract, RESULTS, sentence 9" } ] }, { "id": "e5-4", "text": "The authors described the 5-year rates of death or disabling stroke as comparable, and valve durability and performance as excellent in both groups.", "cites": [ { "snapshot_id": "cardio:pubmed-40158212-2026-10-15", "locator": "Abstract, CONCLUSIONS, sentences 1 and 2, parts" } ] } ] }, { "heading": "A 2010 trial in people who could not have surgery", "statements": [ { "id": "t10-1", "text": "In a 2010 trial, 358 people with severe aortic stenosis whom surgeons judged not suitable for surgery were randomly assigned to TAVI or to standard therapy.", "cites": [ { "claim": "cardio:claim-tavr-2010-mortality" } ] }, { "id": "t10-1b", "text": "The standard therapy included balloon aortic valvuloplasty.", "cites": [ { "claim": "cardio:claim-tavr-2010-mortality" } ] }, { "id": "t10-2", "text": "This trial compared TAVI with standard therapy and not with surgery, because the people in it could not have surgery.", "cites": [ { "claim": "cardio:claim-tavr-2010-mortality" } ] }, { "id": "t10-3", "text": "At 1 year, 30.7% of the TAVI group and 50.7% of the standard therapy group had died from any cause.", "cites": [ { "claim": "cardio:claim-tavr-2010-mortality" } ] }, { "id": "t10-4", "text": "At 30 days, the abstract reports more major strokes with TAVI than with standard therapy (5.0% against 1.1%) and more major vascular complications (16.2% against 1.1%).", "cites": [ { "claim": "cardio:claim-tavr-2010-safety" } ] }, { "id": "t10-5", "text": "The authors concluded that TAVI lowered deaths, the combined rate of death or repeat hospital stay, and cardiac symptoms despite the higher rate of major strokes and major vascular events.", "cites": [ { "claim": "cardio:claim-tavr-2010-safety" }, { "claim": "cardio:claim-tavr-2010-mortality" } ] } ] }, { "heading": "A trial of early TAVR in people without symptoms", "statements": [ { "id": "ea-1", "text": "In EARLY TAVR, 901 people with severe aortic stenosis and no symptoms were randomly assigned to early TAVR or to clinical surveillance.", "cites": [ { "claim": "cardio:claim-early-tavr-primary" } ] }, { "id": "ea-surv", "text": "The abstract says guidelines recommended routine clinical surveillance every 6 to 12 months for people with severe aortic stenosis, no symptoms and a preserved left ventricular ejection fraction.", "cites": [ { "snapshot_id": "cardio:pubmed-39466903-2026-10-14", "locator": "Abstract, BACKGROUND, sentence 1" } ] }, { "id": "ea-fu", "text": "The abstract reports a median follow-up of 3.8 years but does not tie the event percentages below to a time point.", "cites": [ { "claim": "cardio:claim-early-tavr-primary" } ] }, { "id": "ea-2", "text": "A primary event, meaning death, stroke or an unplanned hospital stay for heart or blood vessel causes, happened in 26.8% of the TAVR group and 45.3% of the surveillance group.", "cites": [ { "claim": "cardio:claim-early-tavr-primary" } ] }, { "id": "ea-3", "text": "Death occurred in 8.4% of the TAVR group and 9.2% of the surveillance group, and stroke in 4.2% and 6.7%, and the abstract gives no separate test for these parts.", "cites": [ { "claim": "cardio:claim-early-tavr-primary" } ] }, { "id": "ea-3b", "text": "Unplanned hospital stays for heart or blood vessel causes occurred in 20.9% of the TAVR group and 41.7% of the surveillance group.", "cites": [ { "claim": "cardio:claim-early-tavr-primary" } ] }, { "id": "ea-4", "text": "During a median follow-up of 3.8 years, 87.0% of the surveillance group had their aortic valve replaced.", "cites": [ { "claim": "cardio:claim-early-tavr-primary" } ] }, { "id": "ea-5", "text": "The comparison was therefore early TAVR against a strategy after which most people still had their valve replaced.", "cites": [ { "claim": "cardio:claim-early-tavr-primary" } ] } ] }, { "heading": "What a 2020 guideline summary says about choosing", "statements": [ { "id": "gl-1", "text": "For people with severe aortic stenosis for whom a biological valve is appropriate, an ACC summary of a 2020 ACC/AHA guideline says the choice between surgery and TAVI should include several factors.", "cites": [ { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, lead-in, opening words" }, { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, lead-in, fragment 1 of 3" }, { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, lead-in, fragment 2 of 3" }, { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, lead-in, fragment 3 of 3" } ] }, { "id": "gl-date", "text": "The ACC summary is dated December 17, 2020.", "cites": [ { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Page date line" } ] } ] }, { "heading": "When the same summary prefers surgery or TAVI", "statements": [ { "id": "gp-1", "text": "The summary says surgery is preferred for patients younger than 65, or with a life expectancy of more than 20 years.", "cites": [ { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, list item 1" } ] }, { "id": "gp-2", "text": "It says TAVI through the femoral artery is preferred, if feasible, for patients older than 80, or with a life expectancy of less than 10 years.", "cites": [ { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, list item 4" } ] }, { "id": "gp-3", "text": "For symptomatic patients aged 65 to 80 with no reason that rules out TAVI through the femoral artery, it recommends either surgery or TAVI, chosen once the patient and care team have decided together.", "cites": [ { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, list item 5" } ] }, { "id": "gp-4", "text": "It says surgery is preferred if blood vessel anatomy or other factors rule out TAVI through the femoral artery.", "cites": [ { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, list item 2" } ] }, { "id": "gp-5", "text": "It says surgery is preferred for patients without symptoms who have a named reason for the procedure, for example an abnormal result on an exercise test, aortic stenosis that is very severe, fast progression, or a raised BNP blood level.", "cites": [ { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, list item 3, part 1" }, { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, list item 3, part 2" }, { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on intervention for severe AS, sentence 1, part" } ] }, { "id": "gp-6", "text": "It says TAVI is preferred, whatever the age, for patients who have symptoms and a surgical risk that is high or prohibitive, if survival of more than 12 months is predicted and the quality of life expected is acceptable.", "cites": [ { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, list item 6, part 1" }, { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, list item 6, part 2" } ] }, { "id": "gp-7", "text": "It recommends palliative care, after shared decision making, for patients with symptoms whose predicted survival after TAVI is under 12 months or who are expected to gain little in quality of life.", "cites": [ { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, list item 7, part 1" }, { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, list item 7, part 2" } ] } ] } ], "checklists": [ { "heading": "Factors an ACC summary of a 2020 guideline lists for choosing between surgery and TAVI", "items": [ { "id": "gf-1", "text": "The presence of symptoms.", "cites": [ { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, lead-in, fragment 1 of 3" } ] }, { "id": "gf-2", "text": "The patient's age and how long the patient is expected to live.", "cites": [ { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, lead-in, fragment 2 of 3" } ] }, { "id": "gf-3", "text": "The reason for the procedure.", "cites": [ { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, lead-in, fragment 2 of 3" } ] }, { "id": "gf-4", "text": "The predicted risk of surgery.", "cites": [ { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, lead-in, fragment 2 of 3" } ] }, { "id": "gf-5", "text": "Anatomy or other factors that affect whether TAVI can be done through the femoral artery.", "cites": [ { "snapshot_id": "cardio:acc-valve2020-key-perspectives-pt1-2026-10-15", "locator": "Key perspective on SAVR versus TAVI, lead-in, fragment 3 of 3" } ] } ] } ], "questions": [ { "text": "Which of my valves is affected, and is the problem narrowing, leaking or both?", "grounded_in": [ "def-reg", "def-sten", "def-both" ] }, { "text": "Do I have symptoms from the valve, and does that change whether or when a procedure is advised?", "grounded_in": [ "def-worse", "def-sym", "tx-3", "ea-1", "gf-1" ] }, { "text": "Is repair possible for my valve, or is replacement needed?", "grounded_in": [ "tx-5", "tx-6" ] }, { "text": "If a replacement valve is advised, would it be biologic or mechanical, and what would that mean for how long it lasts and for blood thinners?", "grounded_in": [ "tx-7", "tx-8", "tx-9", "os-12" ] }, { "text": "Would open-heart surgery, a catheter procedure or both be options for my valve and general health?", "grounded_in": [ "tx-4", "os-7", "os-8" ] }, { "text": "How is my surgical risk estimated, and how does it affect the choice?", "grounded_in": [ "os-6", "gf-4", "p3-risk" ] }, { "text": "Is my anatomy suitable for placing a valve through the femoral artery?", "grounded_in": [ "gf-5", "route-1", "gp-4" ] }, { "text": "Do the trial results apply to someone with my age, symptoms and surgical risk?", "grounded_in": [ "valves-1", "p3-risk", "el-age", "t10-2", "ea-1" ] }, { "text": "Which of the guideline summary's age and life-expectancy groups applies to me, and what does that mean for choosing between surgery and TAVI?", "grounded_in": [ "gp-1", "gp-2", "gp-3" ] }, { "text": "How long do TAVR valves and surgical valves last, and what do the longer trial results mean for someone of my age?", "grounded_in": [ "tx-7", "p5-4", "p7-4", "e5-3", "e5-4" ] }, { "text": "What are the chances of a stroke, a pacemaker or a leaking valve with each option?", "grounded_in": [ "os-5", "os-10", "os-11", "el-5", "t10-4" ] }, { "text": "How long would I expect to stay in hospital with each option, and what follow-up and medicines would come after?", "grounded_in": [ "p3-5", "os-13" ] } ] }, "content_digest": "f3f20741d4db3eecea71e6755652749cb2347dfe7118e7dde169af63da0f21db", "review": { "content_digest": "f3f20741d4db3eecea71e6755652749cb2347dfe7118e7dde169af63da0f21db", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [], "decisions": [], "milestones": [], "relationships": { "outgoing": [], "incoming": [] }, "page_path": "guides/valve-disease-options/", "context_path": "api/v1/context/cardio--guide-valve-disease-options.md" }