May 15, 2019Open Access
Current results and remaining challenges of trans-catheter aortic valve replacement expansion in intermediate and low risk patients
Key Result
Transcatheter aortic valve replacement has demonstrated non-inferiority to surgical aortic valve replacement in intermediate and low-risk patients with severe aortic stenosis, though challenges remain regarding long-term durability and bicuspid valves.
Structured PICO
P
Population
Patients at intermediate to low surgical risk (STS or EuroSCORE II <4% or logistic EuroSCORE I < 10%)
I
Intervention
Trans-catheter aortic valve replacement (TAVR)
This review highlights that while TAVR is non-inferior in intermediate and low-risk patients, challenges must be addressed before expanding to younger patients.
Limitations
- Lack of long-term (>10 years) transcatheter heart valve durability data
- Exclusion of patients with bicuspid aortic valves from major randomized trials
- Higher rates of permanent pacemaker implantation and paravalvular leak compared to surgery
- Uncertainty regarding the optimal management and clinical impact of subclinical leaflet thrombosis
Abstract
TAVR has become the standard treatment in patients at increased surgical risk (STS or EuroSCORE II ≥4% or logistic EuroSCORE I ≥ 10% or other risk factors not included in these scores such as frailty, porcelain aorta, sequelae of chest radiation) and it is increasingly being performed in patients at intermediate to low (STS or EuroSCORE II <4% or logistic EuroSCORE I < 10%) surgical risk. Although non-inferiority has been demonstrated in intermediate and low-risk patients, several challenges need to be addressed before expansion to younger patients. Current trends, trials results, and remaining challenges are summarized and discussed in this review.