Long-Term Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement Among Patients With Prior Mediastinal Radiation

Background Limited data suggest that transcatheter aortic valve replacement (TAVR) is associated with similar short-term outcomes to surgical aortic valve replacement (SAVR) among patients with a history of mediastinal radiation. However, the long-term outcomes of TAVR versus SAVR in this growing patient population remain unknown. Methods We identified patients with a history of chest radiation who underwent isolated AVR using the multinational TriNetX database from 2010 through 2025. Propensity score matching was performed to account for differences in baseline characteristics. Outcomes included all-cause mortality, stroke, and all-cause hospitalization at 5 years. Results The analysis included 933 patients with prior chest radiation who underwent isolated AVR, of whom 785 (84.13%) underwent TAVR, and 148 (15.86%) underwent SAVR. After propensity score matching, 128 patients were included in each group. In the TAVR group, the mean age was 67.6 ± 10.2 years, and 72.7% were women. In the SAVR group, the mean age was 67.5 ± 8.7 years, and 69.5% were women. There was no statistically significant difference in the rates of all-cause mortality (11.7% vs 12.5%; hazard ratio [HR], 1.044; 95% CI, 0.52-2.12; P = .91), stroke (15.6% vs 13.3%; HR, 1.373; 95% CI, 0.72-2.63; P = .34), and all-cause hospitalization (56.3% vs 64.1%; HR, 0.935; 95% CI, 0.68-1.29; P = .65) between TAVR and SAVR at 5 years. Conclusions In this observational analysis from a multinational database of patients with prior mediastinal radiation, TAVR was associated with comparable long-term outcomes compared with SAVR. Further prospective studies are warranted to confirm these findings.