Honored to moderate #TAVI vs SAVR session at #EACTS2020
Things I learned and worry about:

TAVI is an amazing advance.
A shining example of clinician-industry collaboration.
A less invasive way to fix aortic stenosis is worthy.

But like everything, there are tradeoffs...

Clinicians need a clear-eyed view of the data.

Dr. Barili's meta-analysis clearly shows that over time, (in general), mortality is better with surgery.

Partner III data -- in low-risk AS-- the choice of hospitalization in the primary endpoint is dubious. All other TAVI trials used stroke, death.

At one-year, TAVI looks better. Lots better.

At two years, things are different....

...At 2 years, the primary endpoint favors TAVI, but this delta is driven by higher hospitalizations. The curves for stroke and death are coming together.

Ok... So what, you say, TAVI is way less invasive.

Here is the problem:
Dr. Bavaria presentation of TVT registry data of what is actually happening in the real world shows that low-risk patients are increasingly having TAVI.
But rates of serious complications, stroke, pacemakers, are not budging much.

Another problem:
In Partner III rates of pacemakers (in low risk patients) is higher in TAVI arm. Rates of valve thrombosis is also higher.

These are less concerning problems in higher risk inoperable patients, but big problems in younger patients.

As an outside observer, I concur with @kaulcsmc take that a) we need more data before embracing TAVI in low-risk patients, as is happening b) Just b/c FDA allowed hospitalizations in the Partner III, clinicians discussing these procedures w pts ought to focus on hard outcomes.

Finally -- Kudos to @EACTS for having strong participation from *non-content* experts. This is right out of the #medicalconservative playbook. And it is what you want as a patient-- a (medically) conservative surgeon or cardiologist. https://linkinghub.elsevier.com/retrieve/pii/S0002934319301676