Health Status Benefits of Transcatheter vs Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis at Intermediate Surgical Risk

Baron, Suzanne J.; Arnold, Suzanne V.; Wang, Kaijun; Magnuson, Elizabeth A.; Chinnakondepali, Khaja; Makkar, Raj; Herrmann, Howard C.; Kodali, Susheel; Thourani, Vinod H.; Kapadia, Samir; Svensson, Lars G.; Brown, David L.; Mack, Michael J.; Smith, Craig R.; Leon, Martin B.; Cohen, David J.

doi:10.1001/jamacardio.2017.2039

Cited by 106 publications

(81 citation statements)

References 29 publications

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“…In actuality, patients seem to similarly perceive their quality of life after conventional surgery, SUAVR (especially if performed in minimally invasive fashion) (34), and TAVI at 1-and 2-year follow-up. Nevertheless, procedural costs become comparable to conventional surgery (standard of care) only if hospital length of stay after TAVI lasts 5-6 days less than SAVR (35,36).…”

Section: Quality Of Life and Cost Effectiveness Analysismentioning

confidence: 99%

Comparison of hemodynamic and clinical outcomes of transcatheter and sutureless aortic bioprostheses: how to make the right choice in intermediate risk patients

D’Onofrio

Fabozzo

Gerosa

2017

Ann. Cardiothorac. Surg.

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Current surgical treatment options for aortic valve stenosis (AS), as alternatives to that of conventional operation with a midline sternotomy, include sutureless valve replacement (SUAVR) and transcatheter valve implantation (TAVI). Patients with high surgical risk, or those who are judged to be inoperable, are typically good candidates for the TAVI procedure. The best treatment option in patients with an intermediate risk profile, however, the so called "grey zone", is still currently under debate. Sutureless aortic valve replacement has been recently presented as a valid alternative for patients with low-to intermediate-risk. Data available on prostheses' hemodynamic performance and patients' clinical outcomes play a crucial role in the process of device selection. Compared to TAVI, SUAVR provides lower rate of significant postoperative paravalvular leak (PVL), which has shown to be a predictor for mortality. On the contrary, transcatheter valves seem to perform better in terms of transvalvular mean and peak gradients. Therefore, SUAVR and TAVI are both reliable options in patients with severe aortic valve stenosis, as an alternative to conventional surgery, and the choice of the best device should be tailored to patient's anatomical and surgical characteristics.

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Section: Quality Of Life and Cost Effectiveness Analysismentioning

confidence: 99%

Comparison of hemodynamic and clinical outcomes of transcatheter and sutureless aortic bioprostheses: how to make the right choice in intermediate risk patients

D’Onofrio

Fabozzo

Gerosa

2017

Ann. Cardiothorac. Surg.

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“…However, data from PARTNER 2 and SURTAVI have convincingly demonstrated that TAVR is noninferior to SAVR in intermediate‐risk patients and, if performed via transfemoral access, is associated with improved early health status improvements compared with SAVR 22. Thus, in 2018, it is reasonable to favor TAVR in all operable patients with symptomatic severe AS and increased surgical risk.…”

Section: Do Clinical Trials Of Tavr In Low‐risk Patients Herald the Ementioning

confidence: 99%

“…A much smaller prospective randomized trial of transapical TAVR versus SAVR in operable patients (the STACCATO trial) was stopped early because of a higher complication rate in the transapical TAVR arm, specifically death and stroke 49. Furthermore, health status improvements using the Kansas City Cardiomyopathy Questionnaire at 30 days in the PARTNER 2 study were greater with TAVR compared with SAVR, but only in patients who underwent transfemoral TAVR 22. Those who underwent transthoracic TAVR (transapical or transaortic) did not show any early health status improvement benefit over surgery.…”

Section: Do Clinical Trials Of Tavr In Low‐risk Patients Herald the Ementioning

confidence: 99%

Transcatheter Aortic Valve Replacement in Intermediate‐ and Low‐Risk Patients

Rogers

Thourani

Waksman

2018

JAHA

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“…Two-year follow up in patients treated with TAVR have been comparable to those treated with SAVR. This data has lead the FDA to approving TAVR use in intermediate risk patients (12). This new approval will possibly lead to facing increased complications since more patients will undergo TAVR.…”

Section: Aortic Stenosis (As)mentioning

confidence: 99%

Access site complications in transcutaneous aortic valve replacement: frequency, outcomes, prevention, and treatment

et al. 2018

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Aortic stenosis (AS) is a common cause of valvular heart disease with heavy disease burden in elderly patients. It is present in almost 7% of patients older than 65. The mortality rate increases significantly once it becomes symptomatic with average life expectancy of around 1-year. Symptoms include angina, syncope, or heart failure. This requires either surgical or transcutaneous replacement. Transcutaneous aortic valve replacement (TAVR) use has increased in recent years from high risk patients to now even including intermediate risk patients. With the increased number of procedures performed, one of the consequences is access site complications. These complications can lead to increased hospitalization, cost, infections, and eventually worse outcomes. In this manuscript, we provide a comprehensive review discussing the consequences, outcomes, frequency, predictors and some possible solutions to these complications set forth in these studies.

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Health Status Benefits of Transcatheter vs Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis at Intermediate Surgical Risk

Abstract: clinicaltrials.gov Identifier: NCT01314313.

Cited by 106 publications

References 29 publications

Comparison of hemodynamic and clinical outcomes of transcatheter and sutureless aortic bioprostheses: how to make the right choice in intermediate risk patients

Comparison of hemodynamic and clinical outcomes of transcatheter and sutureless aortic bioprostheses: how to make the right choice in intermediate risk patients

Transcatheter Aortic Valve Replacement in Intermediate‐ and Low‐Risk Patients

Access site complications in transcutaneous aortic valve replacement: frequency, outcomes, prevention, and treatment

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