30-Second Takeaway
- In low-risk AS, TAVR matches SAVR for 6-year survival but needs more late reinterventions, mainly for regurgitation.
- Thoracic branch endoprosthesis shows strong real-world arch performance and outperforms TEVAR plus LSAB for zone 2 disease.
- Across aortic beds, endovascular approaches preserve survival but consistently increase late reintervention versus open surgery.
Week ending February 21, 2026
Durability, complications, and evolving technologies in contemporary valve and aortic practice
Six-year Evolut Low Risk data: comparable survival for TAVR vs SAVR, more reinterventions with TAVR
Among 1,414 low-risk severe symptomatic aortic stenosis patients, 730 underwent TAVR and 684 surgery with planned 10-year follow-up. At 6 years, all-cause death or disabling stroke was similar for TAVR versus surgery (23.3% vs 20.4%; P = 0.43). All-cause mortality did not differ significantly (23.3% vs 20.2%; P = 0.24), indicating no survival advantage for either approach. Reintervention was higher after TAVR, particularly beyond year 6 and mainly for aortic regurgitation rather than stenosis. Using available 7-year data, reintervention reached 9.8% after TAVR versus 6.0% after surgery (sHR 1.68; 95% CI 1.10–2.58). These results underscore the need to counsel younger, low-risk candidates about higher mid-term structural dysfunction and reintervention after TAVR.
Real-world TBE for arch zones 0–2 and zone 2 comparison with TEVAR plus LSAB
This single-center series included 75 patients treated with Gore thoracic branch endoprosthesis in arch zones 0–2, predominantly for dissection. Zone 0 cases had higher 30-day permanent stroke rates and zone 1 cases more myocardial ischemia, reflecting proximal arch complexity. At 1 year, survival was 80.4% with low type Ia endoleak, 60% sac regression, complete false lumen thrombosis, and 100% branch patency. In adjusted zone 2 comparisons, TBE reduced acute kidney injury, myocardial ischemia, length of stay, procedure time, and contrast use versus TEVAR plus LSAB. Zone 2 TBE also improved sac regression and freedom from reintervention (HR 0.26; 95% CI 0.6–0.92). These data support zone 2 TBE as a preferred strategy when anatomy is suitable, while highlighting higher neurologic risk in zone 0.
EVAR vs open AAA repair: similar survival, more reinterventions with EVAR
This systematic review pooled four randomized trials comparing endovascular aneurysm repair and open repair for intact abdominal aortic aneurysm. Overall survival was equivalent (HR 1.02; 95% CI 0.93–1.12), indicating no long-term survival advantage for either strategy. Reintervention risk was significantly higher after EVAR (HR 2.14; 95% CI 1.70–2.70), favoring open repair for durability. Heterogeneity was low, and risk-of-bias assessments did not materially alter findings, strengthening confidence in the estimates. Clinically, EVAR offers perioperative advantages but should be paired with explicit counseling on greater long-term reintervention burden.
ECMO center volume and complications: nuanced trade-offs from the ELSO registry
Using ELSO data from 2018–2021, investigators analyzed 9,427 VV, 10,794 VA, and 3,595 ECPR adult ECMO runs across over 270 centers. Higher annual center volume modestly increased mechanical complications for VA ECMO (aOR 1.004 per case; 95% CI 1.001–1.008). In contrast, greater volume slightly reduced hemorrhagic complications for VV and VA ECMO and pulmonary complications for VV ECMO (aOR 0.997 in both domains). Metabolic complications were not associated with center volume, suggesting selective volume–outcome relationships rather than global effects. Effect sizes were small but volume is known at cannulation, enabling risk adjustment, benchmarking, and arguments for regionalization.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.