Why the study?
Long-term results of transcatheter aortic valve therapies remain uncertain despite an increasing number of studies examining both surgical and transcatheter aortic valve replacement.
Does transcatheter aortic valve replacement compared to surgical aortic valve replacement improve clinical outcomes in patients with severe aortic valve stenosis?
Does transcatheter aortic valve replacement compared to surgical aortic valve replacement improve clinical outcomes in patients with severe aortic valve stenosis?
Both transcatheter and surgical aortic valve replacement are viable options for severe aortic stenosis, and treatment decisions should be guided by a heart team based on robust evidence.
Supports heart team-guided TAVR or SAVR selection in severe AS; confirms both modalities while highlighting degeneration and thrombosis risks.
Aortic stenosis is a disease that is increasing in prevalence and manifests as decreased cardiac output, which if left untreated can result in heart failure and ultimately death. It is primarily a disease of the elderly who often have multiple comorbidities. The advent of transcatheter aortic valve therapies has changed the way we treat these conditions. However, long-term results of these therapies remain uncertain. Recently, there has been an increasing number of studies examining the role of both surgical aortic valve replacement and transcatheter aortic valve replacement. We therefore performed a systematic review using Ovid MEDLINE, Ovid Embase, and the Cochrane Library. Two investigators searched papers published between January 1, 2007, and to date using the following terms: "aortic valve stenosis," "aortic valve operation," and "transcatheter aortic valve therapy." Both strategies in aortic stenosis treatment highlighted specific indications alongside the pitfalls such as structural valve degeneration and valve thrombosis which have a bearing on clinical outcomes. We propose some recommendations to help clinicians in the decision-making process as technological improvements make both surgical and transcatheter therapies viable options for patients with aortic stenosis. Finally, we assess the role of finite element analysis in patient selection for aortic valve replacement. THVT and AVR-S are both useful tools in the armamentarium against aortic stenosis. The decision between the two treatment strategies should be best guided by a strong robust evidence base, ideally with a long-term follow-up. This is best performed by the heart team with the patient as the center of the discussion.
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Iervolino et al. (2021) studied this question.
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