For patients requiring treatment, surgical aortic valve replacement (SAVR) was the sole intervention capable of both relieving symptoms and extending life, until transcatheter aortic valve implantation (TAVI) emerged. Elderly and high-risk individuals were the initial target population for this newer option. Drawing on a sequential cohort of 2500 patients undergoing SAVR with a biologic heart valve (BHV) prosthesis, a comparison was undertaken of age, comorbid burden, procedural complexity, postoperative course, resource demands, and extended survival in eras both predating and following the availability of TAVI. The Carpentier-Edwards valve was the most commonly selected implant, though several additional BHV varieties were also evaluated for outcomes. Individuals receiving SAVR in isolation (i-SAVR) were evaluated separately from those receiving SAVR with another intervention (c-SAVR). The volume of patient referrals climbed steadily until 2016, a point after which TAVI reimbursement criteria were relaxed. Advancing age, a history of percutaneous coronary intervention, diabetes, and chronic kidney disease became increasingly prevalent across both groups over time; meanwhile, atrial fibrillation, urgent SAVR requirements, and various other comorbidities saw a significant rise exclusively in the c-SAVR group. Over the study period, both cohorts experienced greater frequencies of postoperative acute kidney injury, conduction disturbances, and hemorrhagic complications. Although the demand for renal replacement therapy escalated in both surgical populations, the increase was more striking in c-SAVR; a growing requirement for pacemaker insertion (P < 0.001), transfusion products, and reoperation was confined to the c-SAVR cohort. Thirty-day mortality displayed a modest, statistically nonsignificant upward trend over time in both groups. Furthermore, the arrival of TAVI did not modify the trajectory of long-term survival in either cohort. The Carpentier-Edwards Perimount prosthesis demonstrated robust durability over extended follow-up. The Perceval device, selected for more elderly patients, delivered favorable hemodynamic performance but was linked to a substantial rate of postoperative permanent pacemaker dependency. Collectively, the data appear to indicate that expanding TAVI reimbursement beyond the initial 2008 launch was justified. Still, as innovative SAVR technologies continue to emerge, the surgical approach will remain a cornerstone therapy for aortic valve disease.
