Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients over 85 years old†

Sponga, Sandro; Isola, Miriam; Bagur, Rodrigo; Torracchi, Leonardo; Mazzaro, Enzo; Grillo, Maria Teresa; Lechiancole, Andrea; Pompei, Esmeralda; Armellini, Ilaria; Livi, Ugolino

doi:10.1093/icvts/ivx180

Cited by 8 publications

(6 citation statements)

References 26 publications

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“…Estenose valvar aórtica e avanços nos tratamentos A estenose valvar aórtica é considerada a patologia valvular cardíaca mais comum e atinge principalmente os idosos. Após o aparecimento dos sintomas, se a doença não for tratada, a taxa de mortalidade é significativa (GAIA et al, 2010;KATZ;TARASOUTCHI;GRINBERG, 2010;SPONGA et al, 2017).…”

Section: Referencial Teóricounclassified

“…Apesar de poder haver casos em pacientes jovens, a causa mais comum é a calcificação degenerativa da válvula aórtica devido à idade avançada do paciente (OTTO et al, 1999;GAIA et al, 2010). O principal meio de intervenção para estenose valvar aórtica é a técnica cirúrgica convencional, chamada na literatura internacional como surgical aortic valve replacement (SAVR) (GAIA et al, 2010;ANDO et al, 2017;SPONGA et al, 2017). Outras opções atualmente disponíveis são as técnicas balloon aortic valvuloplasty (BAV) e a o transcatheter aortic valve implantation (TAVI), que foram desenvolvidas pelo cardiologista francês Alain Cribier e consideradas ambas minimamente invasivas (CRIBIER et al, 1986;CRIBIER et al, 2002).…”

Section: Referencial Teóricounclassified

“…Desta forma, a presente pesquisa tem como foco estudar os custos de dois tipos de tratamento para a doença valvular cardíaca denominada estenose valvar aórtica. Até o presente momento não há medicamentos capazes de sanar esta doença, sendo necessário um procedimento cirúrgico para substituir a válvula defeituosa (CRIBIER, 2012;ANDO et al, 2017;SPONGA et al, 2017).…”

Section: Introductionunclassified

“…Este grupo é normalmente composto por idosos e pacientes com comorbidades, como diabetes, insuficiência renal, acidente vascular cerebral, entre outros agravantes que elevam o risco de morte na cirurgia. Estima-se que um terço dos pacientes diagnosticados com estenose valvar aórtica faça parte deste grupo considerado inoperável (GAIA et al, 2010;QUEIROGA et al, 2013;SPONGA et al, 2017).…”

Section: Introductionunclassified

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Custo-Efetividade No Tratamento De Estenose Valvar Aórtica: Um Estudo Das Técnicas Bav E Tavi

Roschel

2019

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Doenças cardíacas têm grande impacto no custo total dos hospitais. Com o aumento da expectativa de vida populacional, esta situação tende a se agravar. O objetivo desta pesquisa é analisar o custo-efetividade de duas opções terapêuticas não invasivas para o tratamento da estenose valvar aórtica em pacientes de idade avançada, a valvuloplastia aórtica por balão (BAV) e o implante transcateter de valva aórtica (TAVI). Analisou-se uma amostra de casos do BAV e TAVI obtida entre os beneficiários do plano de saúde do governo do Estado de Santa Catarina, denominado SC-Saúde. Também foram verificados na literatura os desfechos clínicos destes dois tratamentos para confrontar com os resultados desta pesquisa. O TAVI apresentou melhor custo-efetividade em pacientes inoperáveis e com expectativa de vida maior ou igual a 2 anos. Em contrapartida, o BAV apresentou melhor custo-efetividade para pacientes onde a cirurgia convencional não é totalmente descartada ou para pacientes inoperáveis com uma expectativa de vida menor que 2 anos. Portanto, a avaliação do risco e a ponderação da expectativa de vida de cada paciente, são medidas cruciais para direcioná-los aos tratamentos que possam lhes fornecer melhorias na qualidade de vida e na sobrevivência, assegurando o uso sustentável e econômico dos recursos.

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Section: Introductionunclassified

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Custo-Efetividade No Tratamento De Estenose Valvar Aórtica: Um Estudo Das Técnicas Bav E Tavi

Roschel

2019

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“…Surgical aortic valve replacement is the standard of care for symptomatic aortic stenosis, with improvements in both symptoms and survival rates (4). Given that symptomatic aortic stenosis predominantly affects the elderly population, many of these patients have coexisting medical conditions that place them at high risk during open surgical intervention (5).…”

Section: Sa-cme Learning Objectives Introductionmentioning

confidence: 99%

Transcatheter Aortic Valve Replacement: Alternative Access beyond the Femoral Arterial Approach

et al. 2019

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Aortic stenosis is the most prevalent valvular cardiovascular disease affecting the population over the age of 65 years. Transcatheter aortic valve replacement (TAVR) was developed as a minimally invasive surgical intervention to treat aortic stenosis in patients at high risk for surgical complications. Although the most commonly used approach for placement of a transcatheter aortic valve is in retrograde fashion via a transfemoral approach, narrowed luminal diameters, extensive atherosclerotic disease, or significant tortuosity may limit use of this route. In these patients, alternative methods including subclavian, transaortic, and transapical approaches should be considered. An understanding of these access routes and their respective indications and contraindications allows the radiologist to provide additional preprocedure measurements and images to help guide placement of the valve. ©

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Estimating the additional costs per life saved due to transcatheter aortic valve replacement: a secondary data analysis of electronic health records in Germany

et al. 2019

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Aortic stenosis (AS) is the most common valvular heart disease, with a dismal prognosis when untreated. Recommended therapy is surgical (SAVR) or transcatheter (TAVR) aortic valve replacement. Based on a retrospective cohort of isolated SAVR and TAVR procedures performed in Germany in 2015 (N = 17,826), we examine the impact of treatment selection on in-hospital mortality and total in-hospital costs for a variety of at-risk populations. Since patients were not randomized to the two treatment options, the two endpoints in-hospital mortality and reimbursement are analyzed using logistic and linear regression models with 20 predefined patient characteristics as potential confounders. Incremental cost-effectiveness ratios were calculated as a ratio of the risk-adjusted reimbursement and mortality differences with 95% confidence intervals obtained by Fieller's theorem. Our study shows that TF-TAVR is more costly that SAVR and that cost differences between the procedures vary little between patient groups. Results regarding in-hospital mortality are mixed. SAVR is the predominant procedure among younger patients. For patients older than 85 years or at intermediate and higher pre-operative risk TF-TAVR seems to be the treatment of choice. Incremental cost-effectiveness ratios (ICER) are most favorable for patients older than 85 years (ICER €154,839, 95% CI €89,163-€302,862), followed by patients at higher pre-operative risk (ICER €413,745, 95% CI €258,027-€952,273). A hypothetical shift from SAVR towards TF-TAVR among patients at intermediate pre-operative risk is associated with a less favorable ICER (€1,486,118, 95% CI €764,692,323), as the risk-adjusted mortality benefit is relatively small (− 0.97% point), while the additional reimbursement is still eminent (+€14,464). From a German healthcare system payer's perspective, the additional costs per life saved due to TAVR are most favorable for patients older than 85 and/or at higher pre-operative risk.

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Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients over 85 years old†

Abstract: In patients 85 years and older, SAVR seems to offer good short- and mid-term clinical outcomes compared to TAVI. Advanced age alone would not be an indication for TAVI in old-old patients.

Cited by 8 publications

References 26 publications

Custo-Efetividade No Tratamento De Estenose Valvar Aórtica: Um Estudo Das Técnicas Bav E Tavi

Custo-Efetividade No Tratamento De Estenose Valvar Aórtica: Um Estudo Das Técnicas Bav E Tavi

Transcatheter Aortic Valve Replacement: Alternative Access beyond the Femoral Arterial Approach

Estimating the additional costs per life saved due to transcatheter aortic valve replacement: a secondary data analysis of electronic health records in Germany

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