García-Villarreal, Ovidio A

ABSTRACT

The 7-year follow-up of the PARTNER 3 trial provides the most robust randomized evidence comparing balloon-expandable transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis at low surgical risk. Although early analyses demonstrated noninferiority of TAVI, longer-term data reveal temporal heterogeneity of treatment effects, nonproportional hazards, and interpretative dependence on composite endpoint structure. While the primary non-hierarchical composite endpoint shows no statistically significant difference at seven years, all-cause mortality is numerically higher in the TAVI group (19.5 vs. 16.8%). Hazard ratios converge and appear to invert beyond the first year, and restricted mean survival time analyses integrate early benefit with late-phase attenuation. This Point of View examines the methodological and temporal architecture of the 7-year analysis and discusses its implications for durability assessment and long-term decision-making in low-risk patients with extended life expectancy.

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