BACKGROUND Key indicators of the quality of mitral valve (MV) repair for degenerative mitral regurgitation (DMR) are the presence and degree of recurrent (mitral regurgitation (MR) during follow-up, but few studies have provided longitudinal echocardiographic core laboratory-adjudicated data. OBJECTIVES The purpose of this study was to evaluate 2-year survival and MR recurrence in patients who underwent MV repair for DMR with concomitant tricuspid valve (TV) disease between 2016 and 2018. METHODS This is a post hoc analysis of outcomes from a randomized trial (N = 401; 39 sites) evaluating the effects of TV repair during MV surgery for patients with DMR and moderate or less tricuspid regurgitation. Eighty-seven patients (21.7%) were excluded because they underwent MV replacement (32 planned and 9 conversions) or did not have isolated DMR or evaluable echocardiographic data during 2 years. The primary endpoint was a composite of the incidence of all-cause mortality, recurrent severe MR, or MV reoperation (ie, treatment failure) during 2 years. Multivariable modeling identified risk factors for recurrent MR. RESULTS Among 314 eligible patients (median age: 67.4; female: 24.2%), 1.0% (3 of 307) had moderate MR and 0.7% (2 of 307) had severe MR at discharge. Thirty-day all-cause mortality rate was 1.0%. At 2 years, 3.5% (11 of 314) had died, and 2.2% (7 of 314) had MV reoperation. Among 295 survivors free of MV reoperation with evaluable echocardiograms, 9.2% (27 of 295) had moderate MR, 1.4% (4 of 295) had severe MR, and 2.5% (7 of 275) had a mean MV gradient >5 mm Hg. The incidence of death, MV reoperation, or severe MR during 2 years was 8.0% (25 of 313). Patients with anterior or bileaflet MV pathology were at higher risk for treatment failure compared with patients with posterior leaflet pathology (OR: 2.48; 95% CI: 1.09-5.68; P = 0.03). CONCLUSIONS In this international trial with echocardiographic core laboratory adjudication, the rate of survival free from MV reoperation or any episode of severe MR during 2 years was 92% in patients with DMR and concomitant TV disease. These outcomes show that surgical repair achieves high success and durability during 2 years in these patients, providing a contemporary benchmark for clinical decision-making and future trials. (Evaluating the Benefit of Concurrent Tricuspid Valve Repair During Mitral Surgery; NCT02675244) (JACC. 2026;87:3436-3448) (c) 2026 the American College of Cardiology Foundation. Published by Elsevier. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

OBJECTIVE:Patients on ticagrelor who are undergoing cardiac surgery before completing guideline-recommended washout are at high risk for severe bleeding. This study evaluated whether a novel drug removal device reduces bleeding in patients operated within 2 days from ticagrelor discontinuation. METHODS:Eligible patients were randomized 1:1 to intraoperative DrugSorb-ATR or sham control. Primary safety end point was adverse events at 30 days. Efficacy was assessed by composite end points comprising bleeding events using Universal Definition of Perioperative Bleeding (UDPB) and 24-hour chest tube drainage (CTD) in the overall and isolated coronary artery bypass grafting (CABG) populations with a hierarchical win ratio (WR) method. RESULTS:In total, 140 patients were randomized; 132 had surgery and received a study device; and 92% were isolated CABG. Mean age was 65 ± 5 years, and 15% were female. The primary safety end point was met, with similar adverse events reported between groups. The primary efficacy end point was not met in the overall or CABG populations (Win ratio [WR], 1.07; 95% CI, 0.72-1.58; P = .748 and WR, 1.33; 95% CI, 0.86-2.04; P = .202 respectively). The supplementary efficacy end point was met in the CABG population (WR, 1.59; 95% CI, 1.02-2.46, P = .041) with significant reductions also shown in large CTD bleeding events (P = .016) and major bleeding, a composite of severe bleeding events or 24-hour CTD ≥1 L (P = .041). The number needed to treat to prevent a major bleed was 6. CONCLUSIONS:Intraoperative use of DrugSorb-ATR is safe in patients operated within 2 days of ticagrelor discontinuation. Although the primary end point was not met in the overall population, there were significant reductions in severe bleeding events in the prespecified CABG population.

Importance As transcatheter aortic valve replacement (TAVR) is considered for younger and lower-risk populations, the durability of bioprosthetic valves is increasingly important. Limited data exist on long-term (7 years and beyond) valve durability. Objective To report 7-year valve durability outcomes for low-risk patients with symptomatic severe aortic stenosis treated with TAVR vs surgery. Design, Setting, and Participants Between March 2016 and October 2017, a total of 1000 patients were enrolled at 71 centers in the US and Canada and randomized to undergo TAVR vs surgery. The patient population for the present analysis consisted of all patients who underwent valve implantation (495 with TAVR and 453 with surgery). The last 7-year follow-up occurred in March 2025. Interventions Patients were randomized to balloon-expandable TAVR with the SAPIEN 3 valve or surgery with any commercially available valve. Main Outcomes and Measures The main outcomes of this analysis were stage 2 or 3 bioprosthetic valve dysfunction (BVD) related to structural valve deterioration (SVD), thrombosis, or endocarditis; all-cause bioprosthetic valve failure (BVF); BVF related to SVD; and aortic valve reintervention at 7 years. Analyses are presented as cumulative incidence rates with death as a competing risk. Results The mean (SD) age of the study population was 73.5 (6.0) years, and 657 participants (69.3%) were male. Of 671 patients who were still alive and enrolled in the study at 7-year follow-up, 537 (80.0%) were available for echocardiographic analysis. Cumulative incidence rates of stage 2 or 3 SVD-related BVD (7.3% vs 7.6%; hazard ratio [HR], 0.96; 95% CI, 0.59-1.57; P = .88), all-cause BVF (6.9% vs 7.5%; HR, 0.91; 95% CI, 0.55-1.49; P = .69), SVD-related BVF (3.9% vs 5.3%; HR, 0.72; 95% CI, 0.39-1.36; P = .31), and valve reintervention (6.0% vs 5.5%; HR, 1.09; 95% CI, 0.62-1.90; P = .77) were low and similar for TAVR and surgery, respectively. Stage 2 or 3 thrombosis-related BVD (subclinical and clinical) occurred more frequently with TAVR (5.2% vs 0.9%; HR, 5.52; 95% CI, 1.92-15.85; P < .001), although most events occurred within 3 years and few progressed to BVF. Rates of stage 2 or 3 endocarditis-related BVD were also low and similar (0.4% in the TAVR group vs 0.5% in the surgery group; HR, 0.85; 95% CI, 0.12-6.07; P = .87). The proportion of patients alive and free of all-cause BVF was 73.4% (331/451) with TAVR vs 74.8% (288/385) with surgery ( P = .69). Conclusions and Relevance In this ad hoc analysis of a randomized clinical trial among low-risk patients with symptomatic severe aortic stenosis randomized to TAVR or surgery, both TAVR and surgery demonstrated comparable and sustained valve durability, with low and similar rates of SVD, all-cause BVF, and reintervention through 7 years. These findings may inform discussions of valve replacement strategies. Trial Registration ClinicalTrials.gov Identifier: NCT02675114

Background Artificial intelligence (AI) diagnostic models are typically developed in hospital-based populations enriched for disease prevalence and severity, where distinctions between health and disease are pronounced. When deployed in community-dwelling populations with lower prevalence and milder phenotypes, these distinctions may become less well-defined, raising questions about transportability and the impact of disease spectrum on model performance. Objectives The purpose of this study was to evaluate how differences in disease spectrum influence the transportability of AI-based diagnostic models into community-dwelling populations, using artificial intelligence electrocardiogram analysis (AI-ECG) for structural heart disease (SHD) as a test case. Methods EchoNext is an AI-ECG model trained in a multicenter, hospital-based cohort to detect SHD. We evaluated its performance in PREVUE-VALVE (Age and Sex-Specific PREValence of AcqUirEd VALVular Heart DiseasE Study), a community-based study of individuals aged 65 to 85 years undergoing in-home ECG and transthoracic echocardiography. Performance was assessed using area under the receiver operating characteristic curve (AUC) and predictive value and compared with derivation and external hospital-based cohorts, using propensity matching to account for differences in disease prevalence and case mix. Subgroup analyses were performed in clinically relevant populations. Results Among 3,000 PREVUE-VALVE participants, 2,402 met criteria for analysis. Compared with hospital-based cohorts, PREVUE-VALVE had lower SHD prevalence (8% vs 43%), less severe disease, and a shift in phenotype, including more moderate tricuspid regurgitation and less systolic heart failure. Consistent with these differences, model discrimination was lower in PREVUE-VALVE than in the hospital-based cohort (AUC: 71% [95% CI: 66%-76%] vs 83% [95% CI: 82%-83%]). Propensity matching attenuated but did not eliminate this difference, while performance was similar across external hospital-based cohorts, supporting disease spectrum and clinical context as key drivers. Performance was modestly better in PREVUE-VALVE subgroups with higher SHD prevalence and greater disease severity, such as individuals with an abnormal ECG (AUC: 79% [95% CI: 75%-83%]) or impaired health status (AUC: 76% [95% CI: 70%-82%]). Conclusions In a community-dwelling population with lower disease prevalence and milder phenotypes, AI-ECG performance was attenuated relative to hospital-based cohorts, driven by differences in disease spectrum. These findings underscore the impact of both disease prevalence and case mix on AI performance and highlight the importance of model evaluation within intended use populations. (Age and Sex-Specific PREValence if AcqUirEd VALVular Heart DiseasE; NCT05357404)

BACKGROUND:There are limited studies comparing the impact of transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) by annular size. OBJECTIVES:The aim of this post hoc analysis from the PARTNER (Placement of Aortic Transcatheter Valves) 3 trial was to assess the relationship between annular size and outcomes among patients with severe aortic stenosis (AS) who underwent TAVR or SAVR. METHODS:Low-risk patients with severe, symptomatic AS were randomized to TAVR using the balloon-expandable SAPIEN 3 valve or SAVR. Patients were stratified by computed tomographic angiography-derived aortic annular area (small, ≤430 mm2; large, >430 mm2). The primary endpoint was the composite of death, stroke, or rehospitalization. Interactions among annular size, treatment strategy, and adjudicated 5-year clinical outcomes were assessed. RESULTS:Of the 925 patients with available computed tomographic angiography-derived annular size, 293 had small and 632 had large aortic annuli, respectively. Median follow-up duration was 5.2 years (Q1-Q3: 5.0-6.0 years). Five-year rates of the primary endpoint were similar for TAVR and SAVR in the overall cohort, results that were consistent for patients with small (21.2% vs 31.0%; OR: 0.60; 95% CI: 0.35-1.02) and large (23.5% vs 25.5%; OR: 0.90; 95% CI: 0.62-1.29) annuli, without effect modification by annular size (P for interaction = 0.22). Rates of bioprosthetic valve failure were similar and low at 5 years, without effect modification by annular size. Five-year health status was also similar between treatment modalities across annulus strata (P for interaction = 0.12). CONCLUSIONS:TAVR with the SAPIEN 3 valve led to similar 5-year clinical and health status outcomes compared with SAVR, irrespective of annular size. (PARTNER 3 Trial: Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis [P3]; NCT02675114).

BACKGROUND:The TRISCEND II (EVOQUE Transcatheter Tricuspid Valve Replacement: Pivotal Clinical Investigation of Safety and Clinical Efficacy Using a Novel Device) trial demonstrated clinical benefits for transcatheter tricuspid valve replacement (TTVR) with the EVOQUE System over medical therapy for the primary safety and effectiveness endpoint to 1 year. OBJECTIVES:The authors report echocardiographic outcomes at 1 year for the randomized cohort and evaluate hemodynamic and structural changes. METHODS:The multicenter, prospective TRISCEND II trial enrolled 400 patients with severe, symptomatic tricuspid regurgitation (TR) and randomized them in a 2:1 ratio to TTVR (n = 267) or medical therapy (control) (n = 133). The secondary echocardiographic endpoint was reduction in TR severity from baseline to discharge. Echocardiograms were evaluated by an independent echocardiographic core laboratory. RESULTS:All patients had severe TR at baseline; at discharge, 95.5% of patients who underwent TTVR had mild TR. On paired analysis from baseline to 1 year, 95.3% of patients who underwent TTVR and 2.3% of control patients achieved mild TR. Between baseline and 1 year, the mean inferior vena cava diameter decreased significantly more for patients who underwent TTVR (normal breathing P < 0.001; forced inhalation P = 0.038). Patients who underwent TTVR experienced greater improvements in diastolic right ventricular (RV) size (P < 0.05) and larger decreases in RV systolic function (P < 0.001), consistent with reduced preload from TR reduction. RV stroke volume and cardiac output increased significantly in patients who underwent TTVR (P < 0.001) but not in control patients. CONCLUSIONS:One-year echocardiographic outcomes from the TRISCEND II trial demonstrated that near elimination of TR following TTVR is associated with reduced venous congestion, RV reverse remodeling, and significant improvements in forward stroke volume and cardiac output. (EVOQUE Transcatheter Tricuspid Valve Replacement: Pivotal Clinical Investigation of Safety and Clinical Efficacy Using a Novel Device [TRISCEND II Pivotal Trial]; NCT04482062).

BACKGROUND:Transcatheter aortic valve replacement (TAVR) results in early improvements in health status outcomes relative to surgical aortic valve replacement (SAVR) in low-surgical risk patients with symptomatic severe aortic stenosis. However, long-term data comparing the detailed health status outcomes of these 2 treatments are lacking. OBJECTIVE:The purpose of this study was to compare long-term health status outcomes between TAVR and SAVR in low-risk patients and explore heterogeneity of treatment effect. METHODS:The PARTNER 3 (Placement of Aortic Transcatheter Valves) trial randomized patients with severe aortic stenosis and low surgical risk 1:1 to TAVR with a balloon-expandable valve vs SAVR. Health status was evaluated with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and Short Form-36 Heath Survey at baseline and 1 month, 6 months, and annually from years 1 to 7. Between treatment group differences in health status scores over time were examined with mixed effects models for repeated measures adjusted for baseline. RESULTS:The analytic cohort included 943 patients enrolled in the PARTNER 3 trial who had baseline KCCQ assessments and underwent their assigned procedure (494 TAVR, 449 SAVR; mean age: 73.5 ± 5.9 years; 69.2% men; mean Society of Thoracic Surgeons-Predicted Risk of Mortality: 1.9% ± 0.6%; mean KCCQ-overall summary [KCCQ-OS] score: 70.9 ± 20.5). TAVR and SAVR both resulted in significant improvements in KCCQ and Short Form-36 Heath Survey summary scores relative to baseline through 7-year follow-up. KCCQ-OS scores were substantially higher at 1 month after TAVR vs SAVR (mean treatment difference: +16.2 points; 95% CI: 14.3-18.1) and remained modestly higher through 2 years of follow-up (mean difference at 2 years: +1.9 points; 95% CI: 0.2-3.7), but there were no significant between-group differences in years 3-7. At 7 years, ∼60% of patients in both treatment groups had an excellent outcome (alive, KCCQ-OS ≥75; no KCCQ-OS decline ≥10 from baseline). CONCLUSIONS:Patients with severe aortic stenosis at low surgical risk had substantial improvement in patient-reported health status with either TAVR or SAVR that was sustained through 7 years. Patients had earlier recovery with TAVR, but health status outcomes after 2 years were similar between treatment groups. (PARTNER 3 Trial: Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis; NCT02675114).

The 2025 European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines mark a pivotal change, challenging the paradigm of symptom-driven watchful waiting, and supporting earlier treatment in many patients with asymptomatic severe aortic stenosis. Building on this foundation, this international expert perspective advocates a comprehensive, proactive management strategy and offers clinicians a contemporary operational framework for managing severe aortic stenosis. Key evidence-based elements include early referral to the multidisciplinary Heart Valve Team, streamlined evaluation, upstream testing, prompt aortic valve replacement in many asymptomatic patients, more urgent treatment for symptomatic patients, and structured surveillance involving close working relationships between the referring clinician and Heart Valve Team when intervention is deferred. This proactive evidence-based model aims to improve timeliness, efficiency, and equity of care, thereby reducing preventable morbidity and mortality and improving long-term outcomes.

Background Longer-term outcomes are especially important for lower-risk patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). Additional randomized data comparing TAVR and SAVR have recently become available. Objectives The purpose of this study was to perform an updated systematic review with conventional pairwise meta-analyses and pooled survival analyses using reconstructed time-to-event individual participant data (IPD) including the totality of randomized evidence comparing longer-term clinical outcomes after TAVR and SAVR in lower-risk patients. Methods The prespecified primary endpoint was all-cause death. Key secondary endpoints included stroke and the composite of death or disabling stroke. Cox proportional hazards frailty regression and restricted mean survival time models were fitted using reconstructed time-to-event IPD. In sensitivity analyses, proportional odds models were fitted with frailty terms. Conventional pairwise meta-analyses were performed under random and fixed effects assumptions. Results Six trials enrolling 5,341 lower-risk patients were included with 2,717 randomized to TAVR and 2,624 randomized to SAVR (weighted mean follow-up of 35.7 months). At 5 years in the pooled survival analyses of reconstructed time-to-event IPD, TAVR was associated with a 20% reduction in the hazard of all-cause death (HR: 0.80; 95% CI: 0.66-0.97; P = 0.02) and a 19% reduction in the hazard of all-cause death or disabling stroke (HR: 0.81; 95% CI: 0.68-0.96; P = 0.01) compared with SAVR. There was no difference in stroke (HR: 0.97; 95% CI: 0.74-1.26; P = 0.80). Conclusions In lower-risk patients, TAVR was associated with a reduced hazard of death and death or disabling stroke compared with SAVR, while rates of stroke were equivalent. Most patients have not yet undergone 5-year follow-up, and so these findings may change as further longer-term data become available. The present data are informative for lower-risk patients and treating clinicians, but further randomized trials and longer-term follow-up are required, particularly in younger patients.

INTRODUCTION:Atrial fibrillation (AF) affects 10-20% of patients undergoing coronary artery bypass grafting (CABG) and is associated with increased postoperative morbidity and mortality. Although studies support the safety and effectiveness of surgical ablation (SA), and guidelines recommend its use during CABG for patients with preexisting AF, clinical adoption remains limited. AREAS COVERED:In this review, we outline current guideline recommendations, evaluate the evidence base, highlight recent analyses, and examine persistent barriers to the adoption of SA during CABG, informed by studies identified through searches of PubMed and Google Scholar. EXPERT OPINION:Small randomized studies demonstrate that SA restores sinus rhythm following CABG, while observational studies suggest rhythm restoration improves survival and reduces thromboembolic events. Recent national database analyses have lent further support, finding an association between SA and long-term survival. Analytic approaches included analysis by treatment type using propensity-score risk adjustment and, more recently, using surgeon frequency of SA as an instrumental variable. However, concerns about unmeasured confounding, sparse rhythm follow-up, and limited lesion-set granularity undermine confidence and contribute to underuse. A randomized trial comparing long-term outcomes between pulmonary vein isolation, left atrial, and bi-atrial lesion sets is critically needed to guide optimal implementation of SA during CABG.

OBJECTIVES:Guidelines recommend surgical ablation (SA) during isolated aortic valve replacement (AVR) in patients with pre-existing atrial fibrillation (AF). Nevertheless, SA remains underutilized during AVR, and the impact of SA on long-term outcomes is poorly quantified. We examined the association of SA with survival and the incidence of stroke or transient ischaemic attack (TIA) in Medicare beneficiaries with AF undergoing AVR. METHODS:Medicare claims (2008-2019) were queried to identify patients with AF undergoing AVR; procedural characteristics were doubly adjudicated using hospital and surgeon billing codes. Kaplan-Meier survival estimates were generated for beneficiaries who did and did not receive concomitant SA. Ten-year restricted mean survival times (RMST) were compared; 95% confidence intervals are provided. Outcomes were re-analysed using surgeon frequency of SA as an instrumental variable. Overlap propensity score weighting was performed for risk-adjustment in all analyses. RESULTS:Among 37 666 beneficiaries with AF undergoing AVR, only 8499 (22.6%) underwent SA. Surgeons were categorized by quartile of SA frequency during AVR: 1318 infrequently performed SA (<7.5% of cases; 9438 beneficiaries), whereas 786 frequently performed SA (≥34%; 9353 beneficiaries). Risk-adjusted RMSTs were 6.59 [6.49-6.69] vs 6.21 [6.11-6.31] years in beneficiaries with and without concomitant SA during AVR, a difference of 4.6 [1.8-7.4] months (P < 0.001). Risk-adjusted RMSTs were 6.14 [6.01-6.26] vs 5.94 [5.82-6.06] years for beneficiaries undergoing AVR by frequent and infrequent SA surgeons, a difference of 2.3 [0.2, 4.4] months (P = 0.03). CONCLUSIONS:In Medicare beneficiaries with AF undergoing AVR, utilization of concomitant SA was associated with a clinically modest late survival advantage, as was undergoing surgery by a frequent SA surgeon.

BACKGROUND:The clinical significance of elevated baseline natriuretic peptide level and prior heart failure hospitalization (HFH) within the prior year in mitral transcatheter edge-to-edge repair outcomes is unclear. This analysis examined the impact of BNP (B-type natriuretic peptide) or NT-proBNP (N-terminal pro-B-type natriuretic peptide) and prior HFH on outcomes in patients with severe secondary mitral regurgitation. METHODS:The COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) was a randomized controlled trial of subjects assigned to mitral valve transcatheter edge-to-edge repair with the MitraClip device versus guideline-directed medical therapy alone. COAPT patients were grouped by BNP/NT-proBNP levels and prior HFH within 1 year: (1) Mild heart failure (HF): no prior HFH with BNP/NT-proBNP<median; (2) Moderate HF: prior HFH with BNP/NT-proBNP<median or no prior HFH with BNP/NT-proBNP≥median; and (3) Severe HF: prior HFH and BNP/NT-proBNP≥median. The primary measures were 2-year rates of death or HFH. RESULTS:Of 572 patients, mild, moderate, and severe HF were present in 125 (21.9%), 288 (50.3%), and 159 (27.8%) patients, respectively. With guideline-directed medical therapy alone, the 2-year rates of death or HFH in mild, moderate, and severe HF were 56.4%, 60.5%, and 84.1%, respectively (Ptrend=0.001). These rates were 48.7% and 73.4% among patients with moderate HF and a prior HFH only versus elevated BNP/NT-proBNP≥median only (P=0.003). Mitral transcatheter edge-to-edge repair reduced death/HFH compared with guideline-directed medical therapy alone regardless of HF severity (Pinteraction=0.50). CONCLUSIONS:In patients with HF with severe secondary mitral regurgitation enrolled in the COAPT trial, 2-year rates of death/HFH were increased with an elevated baseline BNP/NT-proBNP≥median, and more so if HFH within 1 year prior had occurred. Treatment with mitral transcatheter edge-to-edge repair reduced all-cause mortality and HFH consistently in mild, moderate, and severe HF. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT01626079.

Background:Prosthesis-patient mismatch (PPM) remains a topic of controversy in patients undergoing transcatheter aortic valve replacement (TAVR), particularly among women with smaller annuli. Although self-expanding valves (SEV) appear to provide superior hemodynamic performance than balloon-expandable valves, the impact of PPM severity on long-term survival, particularly regarding sex-specific differences, remains inadequately characterized. Methods:This retrospective cohort study analyzed 3016 patients (1338 women) who underwent native valve TAVR from 2012 to 2021. Patients were stratified by sex, valve type (balloon-expandable valve vs SEV), and PPM predicted (PPMP) and measured (PPMM) severity as defined by the Valve Academic Research Consortium. The primary outcome was all-cause mortality at 5 years, with secondary outcomes including PPM incidence, severity, and residual transvalvular gradients. Results:Women exhibited higher rates of severe PPMP (1.7% vs 0.1%; P < .001) and severe PPMM (7.3% vs 5.4%; P = .033). Notably, neither moderate nor severe PPMP or PPMM adversely affected 5-year survival in women (severe PPMP hazard ratio [HR], 1.24; P = .709; severe PPMM HR, 1.35; P = .168). SEVs were associated with lower overall PPMP (12.8% vs 31.8%) and PPMM (16.1% vs 31.1%) and superior hemodynamics. Although SEVs demonstrated a nonsignificant lower unadjusted survival (44.4% vs 38.0%; P = .286), 5-year survival was similar within PPM strata after risk adjustment (overall PPMP HR, 0.51; P = .510; overall PPMM HR, 0.77; P = .412). Conclusions:Despite a higher incidence and severity of both PPMP and PPMM, women did not experience decreased long-term survival after TAVR. Additionally, there was no risk-adjusted survival difference between valve types, emphasizing the need for individualized prosthesis selection and lifetime valve management considerations.