Key result
Transcatheter aortic valve implantation is an effective alternative to surgical valve replacement for high-risk patients with aortic stenosis, a condition affecting nearly 5% of those over 75.
Why the study?
Does transcatheter aortic valve implantation improve survival compared to surgical valve replacement or standard therapy in high-risk patients with aortic stenosis?
Does transcatheter aortic valve implantation improve survival compared to surgical valve replacement or standard therapy in high-risk patients with aortic stenosis?
TAVI is an effective and safe alternative to SAVR or standard therapy for high-risk patients with severe aortic stenosis, though paravalvular leak and conduction disturbances remain concerns.
Supports TAVI for high-risk aortic stenosis; leaves open durability, leak, and conduction questions for prospective study.
Aortic stenosis (AS) is a common disorder that affects nearly 5% of individuals over 75 years of age. Many patients with AS are unable to undergo surgical valve replacement (SAVR) as they are commonly deemed to be of very high risk. Transcatheter aortic valve implantation (TAVI), introduced in 2002, is a new method for treatment of these patients. Computed tomography (CT) is becoming the gold standard imaging modality for preprocedural planning, including assessment of annular size and access. Since 2002, >100,000 procedures have been performed with either a balloon-expandable valve (Edwards SAPIEN valve) or the self-expanding valve (Medtronic CoreValve). A growing body of evidence supporting the effectiveness and safety of TAVI includes the PARTNER trial and the CoreValve pivotal trial. These have found significantly better survival for the TAVI arm compared with SAVR (CoreValve). There were no significant differences in all-cause mortality between TAVI and SAVR, whereas significantly reduced all-cause mortality was observed for TAVI when compared with standard therapy (PARTNER). Paravalvular regurgitation is increased in TAVI compared with SAVR; however, integration of CT into valve selection has shown to improve outcomes. There is conflicting evidence regarding increased risk for stroke after TAVI, and occurrence of conduction disturbances and the need for a pacemaker after TAVI remain a concern. Upcoming trials are focusing on assessing outcomes for use of TAVI in intermediate-operative risk patients. The future will likely include an increased choice of devices, smaller access sites, and further integration of CT for preprocedure planning.
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Grunau et al. (2015) conducted a review in Aortic stenosis. Transcatheter aortic valve implantation (TAVI) vs. Surgical aortic valve replacement (SAVR) or standard therapy was evaluated. Transcatheter aortic valve implantation is an effective alternative to surgical valve replacement for high-risk patients with aortic stenosis, a condition affecting nearly 5% of those over 75.
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