Key result
TAVR was associated with reduced 30-day mortality compared to SAVR for radiation-associated severe aortic stenosis.
Why the study?
Surgical aortic valve replacement is associated with adverse outcomes in patients with radiation-associated aortic stenosis, and transcatheter aortic valve replacement may improve outcomes.
Does transcatheter aortic valve replacement improve 30-day outcomes compared to surgical aortic valve replacement in patients with mediastinal radiation-associated severe aortic stenosis?
Cohort (n=4,279)
Yes
Does transcatheter aortic valve replacement improve 30-day outcomes compared to surgical aortic valve replacement in patients with mediastinal radiation-associated severe aortic stenosis?
In patients with radiation-associated severe aortic stenosis, TAVR is associated with lower 30-day mortality and fewer postoperative complications than SAVR, though with higher rates of pacemaker implantation and stroke/TIA.
Answers are grounded in this paper and cite their sources.
TAVR linked to lower 30-day mortality than SAVR in radiation-associated AS; observational data leaves randomized confirmation open.
Background: Surgical aortic valve replacement (SAVR) is associated with adverse outcomes in patients with radiation-associated aortic stenosis. Transcatheter aortic valve replacement (TAVR) may improve outcomes in this population. Methods: We evaluated 1668 TAVR and 2611 patients with SAVR enrolled in the Society of Thoracic Surgeons’ database between 2011 and 2018. Multiple logistic regression was used to compare 30- day outcomes between TAVR and SAVR. Propensity-matched analysis was performed to confirm results of the overall cohort. Additionally, the cohort was stratified into early (2011–2014) versus contemporary (2015–2018) TAVR eras, and 30-day outcomes for TAVR and SAVR were compared. Finally, outcomes with transfemoral TAVR versus SAVR were compared. Results: In the overall cohort, TAVR was associated with significantly reduced 30-day mortality (odds ratio [OR] TAVR/SAVR =0.60 [0.40–0.91]). Postoperative atrial fibrillation, pneumonia, pleural effusion, renal failure, and bleeding also occurred less frequently with TAVR. Stroke/transient ischemic attack (TIA; OR TAVR/SAVR , 2.03 [1.09–3.77]) and pacemaker implantation (OR TAVR/SAVR , 1.62 [1.21–2.17]) were higher with TAVR. Propensity-matched analysis yielded similar results as the overall cohort. Following stratification by era, TAVR versus SAVR was associated with reduced 30-day mortality in the contemporary but not early era (OR Early , 0.78 [0.48–1.28]; OR Contemporary , 0.31 [0.14–0.65]). Pacemaker implantation was higher with TAVR versus SAVR in both eras (OR Early , 1.60 [1.03–2.46]; OR Contemporary , 1.64 [1.10–2.45]). There was also a nonsignificant trend towards increased stroke/TIA with TAVR during both eras (OR Early , 1.39 [0.58–3.36]; OR Contemporary , 2.46 [0.99–6.10]). Finally, transfemoral TAVR (N=1369) versus SAVR revealed similar findings as the overall cohort; however, the association of TAVR with stroke/TIA was not statistically significant (OR Stroke/TIA , 1.57 [0.79–3.09]). Conclusions: TAVR provides an effective and evolving alternative to SAVR for radiation-associated severe aortic stenosis and was associated with lower 30-day mortality and postoperative complications. TAVR was associated with increased pacemaker implantation and a trend towards increased stroke/TIA. In this unique population with extensive valvular and vascular calcifications, the risk of stroke/TIA with TAVR requires careful consideration and further investigation.
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Nauffal et al. (2021) conducted a cohort in Radiation-associated severe aortic stenosis (n=4,279). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on 30-day mortality (OR 0.60, 95% CI 0.40-0.91). TAVR was associated with reduced 30-day mortality compared to SAVR for radiation-associated severe aortic stenosis.
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