Transcatheter (TAVR) versus surgical (AVR) aortic valve replacement: Occurrence, hazard, risk factors, and consequences of neurologic events in the PARTNER trial

Miller, D. Craig; Blackstone, Eugene H.; Mack, Michael J.; Svensson, Lars G.; Kodali, Susheel; Kapadia, Samir; Rajeswaran, Jeevanantham; Anderson, William N.; Moses, Jeffrey W.; Tuzcu, E. Murat; Webb, John G.; Leon, Martin B.; Smith, Craig R.

doi:10.1016/j.jtcvs.2012.01.055

Cited by 295 publications

(182 citation statements)

References 39 publications

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“…Recent studies identified balloon post-dilatation and valve dislodgement as acute stroke predictors, while new onset atrial fibrillation (AF) was identified as subacute stroke predictor and age, chronic AF, history of stroke, TIA and peripheral vascular disease or coronary artery disease as late stroke predictors (27)(28)(29)(30). The recently presented Sentinel Trial proved that MRI baseline FLAIR Volumes is a strong predictor of a new lesion volume after TAVR (31).…”

Section: Strokementioning

confidence: 99%

Pros and cons of transcatheter aortic valve implantation (TAVI)

Terre¹,

George²,

Smith³

2017

Ann. Cardiothorac. Surg.

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Transcatheter aortic valve implantation (TAVI) or replacement (TAVR) was recently approved by the FDA for intermediate risk patients with severe aortic stenosis (AS). This technique was already worldwide adopted for inoperable and high-risk patients. Improved device technology, imaging analysis and operator expertise has reduced the initial worrisome higher complications rate associated with TAVR, making it comparable to surgical aortic valve replacement (SAVR). However, many answers need to be addressed before adoption in lower risk patients. This paper highlights the pros and cons of TAVI based mostly on randomized clinical trials involving the two device platforms approved in the United States. We focused our analysis on metrics that will play a key role in expanding TAVR indication in healthier individuals. We review the significance and gave a perspective on paravalvular leak (PVL), valve performance, valve durability, leaflet thrombosis, stroke and pacemaker requirement.

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Section: Strokementioning

confidence: 99%

Pros and cons of transcatheter aortic valve implantation (TAVI)

Terre¹,

George²,

Smith³

2017

Ann. Cardiothorac. Surg.

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“…19 Neurologic events were more frequent with TAVR at follow-up at 30-days as well as at 2-years. 20 Bleeding complications were less frequent with TAVR than in the surgery group, whereas vascular complications and paravalvular regurgitation occurred more often after TAVR. 17 During follow-up, regurgitation remained unchanged or improved in the majority of patients.…”

Section: Source Registrymentioning

confidence: 88%

Transcatheter aortic valve replacement

Damberg¹,

Benstoem²,

Autschbach³

et al. 2013

RRCC

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Abstract:The standard treatment for symptomatic severe aortic valve stenosis is surgical aortic valve replacement. Over the last decade, transcatheter aortic valve replacement has emerged as an option for patients judged inoperable. It might also constitute an alternative for high-risk patients, even though which patients might benefit from this approach is still being discussed and remains controversial. Transcatheter heart valve replacement is a rapidly spreading technology. However, a number of problems still need to be addressed, such as paravalvular regurgitation, stroke rate, and postoperative conduction disturbances. Further, the durability of transcatheter heart valves remains unclear. Randomized clinical trials and long-term follow-up will help define the role of transcatheter heart valve replacement in aortic stenosis therapy.

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“…[1][2][3][4][5][6][7][8][9][10] The technique utilized in our unit, i.e. J-sternotomy is also known as an upper hemisternotomy and is a routinely performed minimally invasive AVR technique in many centers.…”

Section: Discussionmentioning

confidence: 99%

J-sternotomy incision for aortic valve surgery: an initial experience of a tertiary care hospital

Erkanlı¹

2016

Cardiovasc Surg Int

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Objectives: This study aims to present our single-center experience of an aortic valve replacement using a minimally invasive J-sternotomy incision and to compare the early clinical outcomes of these procedures with a median sternotomy. Patients and methods:Between January 2014 and May 2015, 38 patients underwent isolated aortic valve replacement operations using a minimally invasive or a conventional sternotomy. A J-sternotomy (group JS) incision was used on 18 patients (12 males, 6 females; mean age 57.0±17.9 years; range 19 to 62 years), whereas a median sternotomy (group MS) incision was performed on 20 patients (13 males, 7 females; mean age 57.4±16.3 years; range 22 to 65 years). Preoperative characteristics, perioperative data and early outcomes were compared. Patient selection techniques, the surgical approach and our experience during the procedures were presented. Results:No mortality developed. The types (p=0.36) and dimensions (p=0.99) of implanted aortic valves were similar between the groups. There was no significant difference between the JS and MS groups in terms of cross-clamp (68.4±30.1 vs. 64.7±29.9 minutes, p=0.70) and cardiopulmonary bypass time (112.3±43.1 vs. 94.8±43.8 minutes, p=0.22). In the group JS, conversion to full sternotomy was needed in one patient due to poor surgical exposure. The lengths of intensive care unit [1.7±1.7 vs 2.2±1.2 days, (p=0.33)] and hospital [7.1±2.7 vs 7.2±1.2 days, (p=0.66)] stays were similar between the groups. A mediastinal exploration due to bleeding was performed using a full sternotomy in two patients (11.2%) from group JS. There was no significant difference in postoperative complications. Conclusion:Since it is minimally invasive for aortic valve replacement using a J-sternotomy incision is a safe and reproducible procedure. The use of a minimally invasive aortic valve replacement technique does not lead to a higher incidence of postoperative complications and associated mortality.

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Transcatheter (TAVR) versus surgical (AVR) aortic valve replacement: Occurrence, hazard, risk factors, and consequences of neurologic events in the PARTNER trial

Abstract: After either treatment, there were 2 distinct hazard phases for neurologic events that were driven by different risk factors. Neurologic complications occurred more frequently after TAVR than AVR early, but thereafter the risk was influenced by patient- and disease-related factors.

Cited by 295 publications

References 39 publications

Pros and cons of transcatheter aortic valve implantation (TAVI)

Pros and cons of transcatheter aortic valve implantation (TAVI)

Transcatheter aortic valve replacement

J-sternotomy incision for aortic valve surgery: an initial experience of a tertiary care hospital

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