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Transcatheter versus surgical aortic valve replacement for severe aortic stenosis: Pat Garrett versus Billy the Kid?

2021; Oxford University Press; Volume: 61; Issue: 5 Linguagem: Inglês

10.1093/ejcts/ezab528

1873-734X

Giovanni Alfonso Chiariello, Enrico Romagnoli, Giuseppe Biondi‐Zoccai, Giacomo Frati,

Coronary Interventions and Diagnostics

An eye for an eye will only make the whole world blind Mahatma Gandhi Despite recent momentous developments, the management of aortic stenosis remains a challenging issue, with an ongoing duelling between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) [1–2]. In an utmost recent meta-analysis, Barili et al. have aimed at pooling recent randomized trials on TAVR versus SAVR, appraising early as well as late outcomes [3]. This work appears very timely given recent calls to expand indications to TAVR in younger and/or lower-risk patients, especially given its conclusions that ‘TAVR became a risk factors for all-cause mortality after 24 months and for rehospitalization after 6 months’. Before accepting ipso facto these results, we must recognize that they are based on an evident different outcome pattern risk in patients treated with TAVR when compared to those receiving SAVR. In summary, the authors, starting from a variable intrinsic risk of the 2 procedures, applied a sequential land-mark analyses approach fragmenting the outcome incidence on the basis of a visual inspection of the scaled Schoenfeld residuals and of the Kaplan–Meier curves [3]. The initial encouraging results of TAVR were overwhelmed by SAVR performance when the surgical risk complications are a far memory. Like in a Zeno's paradox, it seems simply a mathematical question, but it is credited as a source of dialectic contents. Putting aside the statistical diatribe, the work by Barili et al., offers important food for thought.