Aortic Stenosis-Associated Cardiac Damage: A Comparison Between Patients Treated with Surgery and Transcatheter Aortic Valve Replacement

<b>Background/Objectives</b>: In patients with severe aortic stenosis (AS), extra valvular cardiac damage is associated with outcomes following intervention. We aimed to analyze differences in AS-related cardiac damage between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) patients in a contemporary cohort of patients with severe AS. <b>Methods</b>: Patients who underwent SAVR or TAVR in a tertiary care center from 2017 to 2022 were included in this retrospective analysis. Clinical and echocardiographic parameters before surgery were compared, and patients were classified according to two available cardiac damage staging systems. Additionally, all-cause mortality 1-year post-intervention was assessed according to these stages. <b>Results:</b> Eight hundred and seventy-four patients were included (524 underwent TAVR and 350 underwent SAVR). TAVR patients were significantly older (81.9 ± 6.1 vs. 69.5 ± 9.5 years; <i>p</i> < 0.001), more commonly female (52.4% vs. 37.7%; <i>p</i> < 0.001), and had higher surgical risk (EuroSCORE II 6.2 ± 7.0 vs. 2.7 ±3.3; <i>p</i> < 0.001). Compared with SAVR, patients treated with TAVR had significantly more advanced (right-sided) cardiac damage, both with Généreux (37.8% vs. 23.1%; <i>p</i> < 0.001) and Gutiérrez-Ortiz (16.5% vs. 9.0%; <i>p</i> = 0.007) staging systems. Moreover, regardless of the type of intervention or the staging system used, mortality was significantly higher in patients with right-sided damage. <b>Conclusions</b>: In a contemporary cohort of severe symptomatic AS patients, those treated with TAVR had significantly more extensive cardiac damage compared with those who underwent SAVR. This finding raises the question of when to intervene in patients chosen for TAVR. Earlier intervention, before advanced cardiac damage ensues, might help to improve outcomes.