What does this research mean for the field?

Transcatheter aortic valve replacement is safe and effective for patients with rheumatic aortic stenosis, significantly reducing 1-year composite adverse outcomes compared to non-rheumatic patients, despite an increased risk of pacemaker implantation and valve displacement. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

February 21, 2026BMC Cardiovascular Disorders0 citationsOpen Access

Clinical efficacy of transcatheter aortic valve replacement in patients with rheumatic aortic stenosis

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Patients with severe aortic stenosis undergoing TAVR, with subgroup analysis of patients having rheumatic aortic stenosis (RAS) vs. non-RAS (n=359). Intervention: Transcatheter aortic valve replacement (TAVR) using self-expanding Venus A transcatheter heart valve vs. Non-rheumatic aortic stenosis patients undergoing TAVR. Primary outcome: Composite 1-year outcome including all-cause mortality, myocardial infarction, cardiac or TAVR-related rehospitalisation, bleeding, and stroke (HR 0.281 for composite outcome in RAS vs. non-RAS after propensity score matching, 95% CI 0.119-0.662, p=0.008).

YWYuxing WangSouth China Agricultural University MWMaode WangArmy Medical University TLTing LiuArmy Medical University

Key Result

Transcatheter aortic valve replacement reduced the 1-year composite adverse outcome by about 72% compared to non-RAS patients (HR 0.281, 95% CI 0.119-0.662, P=0.008) in patients with rheumatic aortic stenosis.

Key Points

Evaluate the efficacy and safety of transcatheter aortic valve replacement in patients with rheumatic aortic stenosis.
359 patients divided into rheumatic aortic stenosis and non-rheumatic groups.
Propensity score matching used for comparability between the groups.
Analyzed primary endpoints including technical success and 1-year composite outcomes.
Technical success and early safety rates similar across both groups.
Patients with rheumatic aortic stenosis had a higher risk for pacemaker implantation and transcatheter heart valve displacement.
Rheumatic aortic stenosis group demonstrated superior outcomes at 1 year despite increased risks.

Study Design

Type

Cohort (n=359)

Multicenter

Structured PICO

Does transcatheter aortic valve replacement (TAVR) improve 1-year composite outcomes and procedural success in patients with rheumatic aortic stenosis compared to non-rheumatic aortic stenosis?

Population

359 patients with severe aortic stenosis (aortic valve pressure gradient > 40 mmHg or maximum velocity > 4 m/s) undergoing TAVR, including 71 with rheumatic aortic stenosis (RAS) and 288 without RAS. Key inclusion: >1 year life expectancy. Key exclusion: previous heart valve surgery and rare prosthesis type.

Intervention

Transcatheter aortic valve replacement (TAVR) using a self-expanding valve (Venus A or Venus A Plus) in patients with rheumatic aortic stenosis (RAS).

Comparator

Transcatheter aortic valve replacement (TAVR) in patients with non-rheumatic aortic stenosis (non-RAS), evaluated using propensity score matching.

Outcome

Technical success, device success, and 1-year composite outcomes (composite of all-cause mortality, myocardial infarction, cardiac or TAVR-related rehospitalisation, bleeding, and stroke).composite

TAVR may be a safe and effective treatment for rheumatic aortic stenosis, demonstrating superior 1-year composite outcomes compared to non-rheumatic AS, despite a higher procedural risk of pacemaker implantation and valve displacement.

Main Result

Effect estimate: HR 0.281 for composite outcome in RAS vs. non-RAS after propensity score matching (95% CI 0.119-0.662)

p-value: p=0.008

Limitations

Single-centre retrospective study with relatively small sample size and single valve type
Short follow-up period and low incidence of adverse events limiting detection of differences
Lack of transesophageal echocardiography for detailed valve morphology assessment
Potential misclassification in RAS grouping due to only selective CT-based evaluation
Unmeasured operator and anatomical factors influencing prosthesis displacement and pacemaker implantation
Study explored only relationship between pacemaker implantation and prosthesis implantation depth

Abstract

Transcatheter aortic valve replacement (TAVR) is contraindicated for rheumatic aortic stenosis (RAS). Evidence on the efficacy and safety of TAVR is scarce despite several cases of RAS recorded in China. This study aimed to evaluate the efficacy of TAVR in patients with RAS. A total of 359 patients were enrolled and divided into the RAS ( n = 71) and non-RAS ( n = 288) groups according to the World Heart Federation guidelines for rheumatic heart disease combined with computed tomography imaging. Propensity score matching was performed to ensure comparability between groups. A self-expanding valve was used in all the patients. Primary endpoints included technical success, device success, and 1-year composite outcomes. Short-term complications and anatomical differences were analysed. Patients with RAS had higher N-terminal pro-B-type natriuretic peptide levels and Society of Thoracic Surgeons scores, higher atrial fibrillation rates, and worse cardiac metrics (enlargement, valve regurgitation, and lower estimated glomerular filtration rates). The patients in the RAS group had fewer bicuspid valves, less calcification, more elliptical annuli, and larger left ventricular outflow tract/annulus area ratios. The RAS group had a higher prosthesis positioning and oversizing rate. Technical success, device success, and early safety rates were similar between groups. However, the RAS group had a higher pacemaker implantation and transcatheter heart valve displacement (THVD) risk, yet demonstrated superior 1-year outcomes. TAVR may be safe and effective for the treatment of RAS. The anatomical characteristics of patients with RAS increased the risk of THVD and pacemaker implantation. A high-release strategy and appropriate oversizing could partially alleviate the risk of THVD. TAVR, transcatheter aortic valve replacement; RAS, rheumatic aortic valve stenosis.

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Cite This Study

Wang et al. (Wed,) conducted a cohort in Patients with severe aortic stenosis undergoing TAVR, with subgroup analysis of patients having rheumatic aortic stenosis (RAS) vs. non-RAS (n=359). Transcatheter aortic valve replacement (TAVR) using self-expanding Venus A transcatheter heart valve vs. Non-rheumatic aortic stenosis patients undergoing TAVR was evaluated on Composite 1-year outcome including all-cause mortality, myocardial infarction, cardiac or TAVR-related rehospitalisation, bleeding, and stroke (HR 0.281 for composite outcome in RAS vs. non-RAS after propensity score matching, 95% CI 0.119-0.662, p=0.008). Transcatheter aortic valve replacement reduced the 1-year composite adverse outcome by about 72% compared to non-RAS patients (HR 0.281, 95% CI 0.119-0.662, P=0.008) in patients with rheumatic aortic stenosis.

synapsesocial.com/papers/69994ba9873532290d01fbbe https://doi.org/https://doi.org/10.1186/s12872-026-05636-9

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