Patients with moderate aortic stenosis who also carry at least one at-risk feature fared better when treated with transcatheter aortic valve replacement (TAVR) sooner rather than watched over time, according to results from the PROGRESS trial. The findings were presented at TCT 2026 and published at the same time in the New England Journal of Medicine, as reported by the American College of Cardiology.
The trial randomized 744 patients across 74 centers in the United States, Japan, Australia, Europe and Canada. Participants had a mean age of 78, 39.1% were women, and 45.6% were classified as low surgical risk. Half underwent TAVR and half were managed with clinical surveillance.
The primary effectiveness endpoint was a composite of death or a heart failure event at two years after the procedure. That endpoint occurred in 16.7% of the TAVR group versus 23.9% of the surveillance group, a risk difference of –7.2 percentage points (95% CI, –13.1 to –1.3; p=0.02 for superiority).
Why it matters
Moderate aortic stenosis has often been treated as a condition to monitor rather than intervene on, with surgery or TAVR reserved for patients whose disease has progressed to severe. The PROGRESS results challenge that default for a specific subset of patients — those whose disease carries markers suggesting faster progression or worse cardiovascular outcomes.
The trial defined an at-risk feature as a symptom or a structural or functional abnormality previously linked to quicker disease progression or adverse cardiovascular events. For those patients, waiting carried measurable cost: roughly one in four in the surveillance arm reached the death-or-heart-failure endpoint within two years.
The results also carry commercial weight. Edwards Lifesciences, which makes TAVR devices, reported the superior results compared with clinical surveillance in its own announcement, coverage of which appeared via TradingView and other outlets. A positive trial in a moderate-AS population would widen the addressable group for transcatheter valves beyond severe disease.
Secondary endpoints and quality of life
The trial's secondary findings moved in the same direction as the primary result. A composite of death, stroke or heart failure hospitalization at two years occurred in 17.7% of TAVR patients and 23.3% of surveillance patients.
Heart failure hospitalization alone was recorded in 26 TAVR patients and 52 surveillance patients — 7.4% versus 14.9%.
Quality of life also diverged. Thirty-nine percent of TAVR patients were alive with an improvement of at least 10 points on the KCCQ overall summary score, compared with 23.2% of those under surveillance.
Over the two-year follow-up, 204 patients in the surveillance group eventually underwent aortic valve replacement. About 80% of them had progressed to severe aortic stenosis by the time of the procedure — a detail that underscores how many watched patients deteriorate before treatment.
A narrower recommendation than the headline suggests
Philippe Genereux, MD, FACC, the trial's lead author, said the condition should not be taken lightly. He said patients with moderate aortic stenosis should be referred promptly to a valve clinic for full evaluation so the best management approach can be chosen. He added that the trial shows patients with moderate disease and at-risk features can safely benefit from earlier TAVR and should not wait for progression, gaining better quality of life and avoiding a decline in health status.
An accompanying editorial by Catherine M. Otto, MD, FACC, set limits on how far the data should be applied. She wrote that TAVR is not appropriate for most adults with moderate aortic stenosis. The trial's findings, she said, suggest it may be considered in selected older patients who have coexisting conditions and a high risk of adverse outcomes when other treatment approaches are not effective.
That framing matters for clinicians deciding whether to refer. The trial enrolled an older population with at-risk features, not the full spectrum of moderate aortic stenosis. The editorial's caution keeps the result tied to that narrower group rather than opening early TAVR to everyone with moderate disease.
Separately, an update from the EARLY TAVR trial highlighted economic benefits of treating asymptomatic aortic stenosis, according to Cardiovascular Business — a sign that cost and resource questions are becoming part of the debate alongside clinical outcomes.
What to watch
The next questions are how quickly valve clinics absorb referrals for moderate-AS patients with at-risk features, and whether regulators and payers treat the PROGRESS population as a distinct indication for earlier TAVR.
