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Heart Failure Phenotypes and Outcomes After TAVR vs SAVR: A Trinetx Database Analysis
Abstract   Peer reviewed

Heart Failure Phenotypes and Outcomes After TAVR vs SAVR: A Trinetx Database Analysis

N. Nair, S.S. Dhanoa, D. Du and B. Mahesh
The Journal of heart and lung transplantation, v 45(5), pp 614-614
Apr 2026
DOI: https://doi.org/10.1016/j.healun.2026.02.1341

Abstract

Purpose: This study investigates the 1-year survival probability of heart failure (HF) patients undergoing transcatheter (TAVR) versus surgical AVR (SAVR). The survival outcomes of different HF phenotypes undergoing TAVR versus SAVR is not well understood. Methods: Retrospective analysis of adult patient data from TriNetx with aortic stenosis undergoing TAVR or SAVR was performed. We excluded aortic regurgitation/mixed aortic stenosis/ aortic regurgitation, bicuspid valve, endocarditis, prosthetic valve degeneration, and concurrent CABG. Patients were stratified by HF (HF+ vs HF−) and, within HF, by EF. Outcomes (death, HF, stroke, MI, AKI, pneumonia, acute respiratory failure, prolonged intubation, sepsis, AF/flutter) were assessed at 12 months. Cox regression /log-rank analysis was performed. Kaplan-Meier Curves were constructed for survival probabilities. Results: Across the matched AVR cohort, HF patients (n=4549) had higher 12-month mortality vs no HF (n=4549) (11.0% vs 5.8%; HR 2.19, 95% CI 1.99s no HF-2.40). Among HF patients (HFrEF (n=3032) vs HFpEF (n=3032)), HFrEF had higher 12-month mortality (13.4% vs 10.7%; HR 1.24, 1.09-1.42). In HF patients, TAVR (n=671) vs SAVR ( n=671), TAVR showed higher 12-month mortality (12.0% vs 8.5%; HR 1.54, 1.20-2.00) despite fewer early complications (AF/flutter, pneumonia, acute respiratory failure, prolonged intubation). The TAVR mortality disadvantage persisted in HFrEF (HR 1.63) and HFpEF (HR 1.69). Survival probabilities are shown in Figure 1. Conclusion: In a large, real-world cohort of HF patients, SAVR was associated with lower 12-month mortality than TAVR despite TAVR’s lower early complication rates. Differences in nonfatal events likely reflect competing risks and coding granularity. Future studies are needed in this area.

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