Transcatheter Aortic-Valve Replacement in Low-Risk Patients at Five Years

To the Editor: In their article, Mack et al. (Nov. 23 issue)(1) imply that transcatheter aortic-valve replacement (TAVR) provides results that are similar to those of surgical aortic-valve replacement in low-risk patients with severe, symptomatic aortic stenosis. We believe that this assessment is premature because the treatment of aortic-valve disease is a lifelong process. More than 20% of the patients in the TAVR group had paravalvular aortic regurgitation of mild or greater severity as compared with 3% of those in the surgery group. Survival is known to be worse among patients with paravalvular aortic regurgitation than among those without the . . .