Key result
Contemporary SAVR linked to ~3 mmHg lower mean transaortic gradient vs. pre-TAVR era.
Why the study?
To compare valve size, area, and transaortic mean gradients in SAVR patients before versus after the implementation of TAVR.
Does bioprosthetic surgical aortic valve replacement performed in the contemporary post-TAVR era (2019-2020) result in lower transaortic mean gradients and larger valve sizes compared to the early pre-TAVR era (2011-2012)?
Cohort (n=264)
No
Does bioprosthetic surgical aortic valve replacement performed in the contemporary post-TAVR era (2019-2020) result in lower transaortic mean gradients and larger valve sizes compared to the early pre-TAVR era (2011-2012)?
In the contemporary post-TAVR era, patients undergoing surgical aortic valve replacement are younger and lower risk and receive larger bioprosthetic valves, resulting in lower post-operative transaortic gradients and less patient-prosthesis mismatch compared to the early TAVR era.
Answers are grounded in this paper and cite their sources.
Larger valves may yield lower gradients in contemporary SAVR; leaves open whether this improves long-term outcomes.
Background and Aims Transcatheter aortic valve replacement (TAVR) is the mainstay of treatment of inoperable and severe high‐risk aortic stenosis and is noninferior to surgical aortic valve replacement (SAVR) for low‐risk and intermediate‐risk patients as well. We aim to compare the valve size, area, and transaortic mean gradients in SAVR patients before and after the implementation of TAVR since being approved by the Food and Drug Administration in 2011. Methods Patients who underwent a bioprosthetic SAVR placement were divided into two groups based on the date of procedure: the early pre‐TAVR implementation group (years 2011–2012) and the contemporary post‐TAVR group (years 2019–2020). The primary endpoint was the mean gradient across the aortic valve within 16 months of surgery. The secondary endpoints included the difference in valve size and various aortic valve echocardiographic variables. Results One hundred and thirty patients had their valves replaced in the years 2011–2012 and 134 in the years 2019–2020. The early group had a significantly higher mean gradient (median of 13 mmHg [interquartile range, IQR: 9.3–18] vs. 10 mmHg [IQR: 7.5–13.1], p = 0.001) and a smaller median effective orifice area index (0.8 cm 2 /m 2 [IQR: 0.6–1] vs. 1.1 cm 2 /m 2 [IQR: 0.8–1.3], p < 0.001). The median valve size was significantly smaller in the early group (median of 21 mm [IQR: 21–23] vs. 23 mm [IQR: 22.5–25], p < 0.001). Conclusion In the contemporary era, surgical patients receive larger valves which translates into lower mean gradients, larger valve area, and lower rates of patient‐prosthesis mismatch than in previous years before the routine introduction of TAVR.
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Chahine et al. (2022) conducted a cohort in Aortic stenosis undergoing bioprosthetic surgical aortic valve replacement (SAVR) (n=264). Contemporary post-TAVR era bioprosthetic SAVR (years 2019-2020) vs. Early pre-TAVR implementation group bioprosthetic SAVR (years 2011-2012) was evaluated on Mean gradient across the aortic valve within 16 months of surgery (mmHg) (p=0.001). Contemporary post-TAVR era SAVR (2019-2020) was associated with a lower median transaortic mean gradient compared to early pre-TAVR era SAVR.
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