Transcatheter aortic valve replacement reduces mortality by an absolute 19% compared with medical therapy in inoperable patients, and is noninferior to surgery in high and intermediate risk patients.
Does transcatheter aortic valve replacement improve outcomes compared to surgical replacement or medical therapy in patients with severe symptomatic aortic stenosis?
TAVR is an effective and noninferior alternative to surgery for intermediate and high-risk patients with severe aortic stenosis, though it carries specific risks like pacemaker implantation and vascular complications.
Absolute Risk Reduction: 19
Absolute Risk Reduction: 19%
Number Needed to Treat: 5
Transcatheter aortic valve replacement (TAVR) has been approved in the United States for intermediate and high-risk patients with severe symptomatic aortic stenosis. More than 80 000 TAVR procedures have been performed in the United States and the number is growing every year. Two valve designs are approved in the United States including the balloon expandable Edwards Sapien prosthesis and self-expanding CoreValve prosthesis. The PARTNER trial of the Sapien valve, involving patients who were considered inoperable, reported a 19% absolute risk reduction in mortality compared with medical therapy, with a number needed to treat of 5. Randomized controlled trials in patients with high and intermediate risk of inhospital mortality based on the Society of Thoracic Surgeons score showed noninferiority of TAVR compared with surgical aortic valve replacement. Major complications associated with TAVR include a 2% to 3% risk of stroke at 30 d, 8% to 25% risk of permanent pacemaker implantation depending on valve design, and 6% risk of major vascular complications. There are some concerns regarding valve durability as this technology is extended to younger patients with lower risk. Five-year follow-up data from the initial PARTNER trials noted appropriate valve performance and hemodynamics in survivors; however, longer follow-up is required to assess the true incidence of structural deterioration. Approximately one-third of TAVR patients are transferred to a transitional care facility after TAVR, and more than 50% of the patients are frail. Cardiac rehabilitation has been reported to be safe in post-TAVR patients and was associated with significant improvements in exercise capacity, functional independence, and frailty.
Goel et al. (Fri,) conducted a review in severe symptomatic aortic stenosis. Transcatheter aortic valve replacement (TAVR) vs. medical therapy or surgical aortic valve replacement was evaluated on mortality (ARR 19%). Transcatheter aortic valve replacement reduces mortality by an absolute 19% compared with medical therapy in inoperable patients, and is noninferior to surgery in high and intermediate risk patients.