Letter by Subramanian et al Regarding Article, 'Comparison Between Transcatheter and Surgical Prosthetic Valve Implantation in Patients With Severe Aortic Stenosis and Reduced Left Ventricular Ejection Fraction'

To the Editor: We read with interest the recent article by Clavel et al.1 With respect to their findings, we have the following comments and questions. First, transaortic valve implantation (TAVI) relieves valvular and subvalvular obstruction, whereas surgical aortic valve replacement (SAVR) relieves only valvular obstruction, which may explain the observed differences. We liberally use subaortic myectomy as an adjunct to SAVR for treating subvalvular obstruction and aortic root enlargement for valvular obstruction to left ventricular ejection; perhaps this is the fair comparison with TAVI. Second, stentless aortic valve replacement provides superior reduction of transvalvular gradients.2 It is notable that none of the surgically implanted valves were stentless valves. The authors have previously shown that …