2-Year Outcomes in Patients Undergoing Surgical or Self-Expanding Transcatheter Aortic Valve Replacement

Abstract

In patients with severe aortic stenosis who are at increased surgical risk, the higher rate of survival with a self-expanding TAVR compared with surgery was sustained at 2 years. (Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve Replacement; NCT01240902).

A Paradox between LV Mass Regression and Hemodynamic Improvement after Surgical and Transcatheter Aortic Valve Replacement

“…10,16 At 1 year, patients who underwent TAVR had significantly lower mean gradients (9.1 ± 3.5 mm Hg vs. 12.4 ± 7.4 mm Hg) and larger EOA (1.9 ± 0.5 cm 2 vs. 1.6 ± 0.5 cm 2 ) than patients who underwent SAVR. However, PWTd (11.24 ± 1.95 to 11.45 ± 1.73 mm, p = 0.159) and interventricular SWTd (12.00 ± 2.07 to 11.99 ± 1.94 mm, p = 0.954) were unchanged in the SAVR group at discharge, as well as in the TAVR group (11.19 ± 1.98 to 11.39 ± 2.05 mm; p = 0.435 and 11.97 ± 2.35 to 12.26 ± 2.41 mm; p = 0.155, respectively).…”

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

“…Należy również rozważyć TAVI u pacjentów wysokiego ryzyka z ciężką stenozą aortalną, którzy mogliby być leczeni chirurgicznie, ale w ocenie kardiogrupy (Heart Team) TAVI jest metodą preferowaną ze względu na indywidualne ryzyko i możliwości anatomiczne [495,496]. W niedawno opublikowanym badaniu u pacjentów z ciężką stenozą aortalną wykonanie TAVI z zastosowaniem samorozprężalnej protezy biologicznej wiązało się z większą przeżywalnością zarówno po roku, jak i po 2 latach [497,498].…”

Rapid adoption of transcatheter aortic valve replacement in intermediate- and high-risk patients to treat severe aortic valve stenosis

“…Two ongoing randomized controlled trials are specifically investigating which anti-thrombotic strategy might be best following TAVR (clinicaltrials.gov: NCT02556203-GALILEO, NCT02664649-ATLANTIS). Finally, another important observation is that most studies report a lower rate of newonset atrial fibrillation in the TAVR group as compared to the SAVR group (6)(7)(8)(9)(10)(11)(12); whether this may be associated with a lower stroke risk at medium term follow-up for TAVR patients still has to be determined. In addition, a number of other procedural complications such as acute kidney injury and major bleeding are only half as common after TAVR than SAVR (4).…”

“…In addition, the first randomized trial comparing TAVR and SAVR in all-comer patients (NOTION) indicated that these findings also apply to patients at even lower surgical risk (8). Figure 1 gives an overview of all-cause mortality rates reported for the different randomized controlled trials comparing TAVR and SAVR (6)(7)(8)(9)(10)(11)(12). Clearly, long-term follow-up data are needed for the lower risk patient populations; however, it will just be a matter of time before these data will become available (clinicaltrials.gov: NCT02825134-NOTION-2, NCT02675114-PARTNER-3, NCT02701283-TAVRlow risk).…”