EVOLUT Low-Risk Trial data: “We see what we want to see!”

In the 4-year update of the EVOLUT Low-Risk Trial (NCT02701283), the authors highlight a non-significant improvement in the primary endpoint and a statistically significant, yet clinically irrelevant, enhancement in hemodynamics with transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR). Overlooking the concurrent surgical procedures in SAVR patients, mortality rates remain similar at 4 years. Unaddressed is the substantial increase in permanent pacemaker implantations with TAVR and the fate of patients with paravalvular leaks.