Structural durability of early-generation Transcatheter aortic valve replacement valves compared with surgical aortic valve replacement valves in heart valve surgery: a systematic review and meta-analysis

Ler, Ashlynn; Ying, Yeo Jie; Sazzad, Faizus; Choong, Andrew M.T.L.; Kofidis, Theo

doi:10.1186/s13019-020-01170-7

Cited by 18 publications

(10 citation statements)

References 25 publications

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“…Furthermore, in the era of transcatheter aortic valve implantation (TAVI), durability appears to be the area of interest when comparing outcomes. In this regard it is noteworthy a recent meta-analysis has highlighted significantly greater durability with surgical AVR prostheses compared with TAVI prostheses [18]. The CEPME prosthesis has been subject to extended in vitro study.…”

Section: Discussionmentioning

confidence: 99%

Mid-term follow-up after aortic valve replacement with the Carpentier Edwards Magna Ease prosthesis

Rajab

Ali

Hernández-Sánchez

et al. 2020

J Cardiothorac Surg

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Background: Approximately 250,000 heart valve operations are performed annually worldwide. An intensive research and development effort has led to progressively more advanced heart valve prostheses. The Carpentier-Edwards Perimount Magna Ease (CEPME) prosthesis represents the latest iteration of the Edwards Perimount series of aortic tissue valves. The current study aims to evaluate the midterm performance of this bioprosthesis. Methods: Five hundred and eighteen patients with aortic stenosis underwent aortic valve replacement with the CEPME valve at Papworth Hospital between August 2008 and November 2011. After a minimum of 3 years from the index operation, eligible patients were retrospectively and consecutively recruited to participate. Recruitment was closed after 100 eligible patients had completed all study assessments. Investigations at follow-up included echocardiography, and NYHA status. Primary endpoints included valve performance measures. Results: The mean age was 72 years, 64% were male and median follow-up was 5.1 years. NYHA status had improved in 66% of patients. The average postoperative peak and mean pressure gradients decreased by 51.2 mmHg (64.5%) and 31.8 mmHg (59.4%), with a significant improvement in NYHA status. The frequency of moderate aortic regurgitation was 3%. There was no evidence for structural valve deterioration. Conclusions: The CEPME has excellent mid-term durability. Its use effectively improves haemodynamics and functional capacity.

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Section: Discussionmentioning

confidence: 99%

Mid-term follow-up after aortic valve replacement with the Carpentier Edwards Magna Ease prosthesis

Rajab

Ali

Hernández-Sánchez

et al. 2020

J Cardiothorac Surg

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“…However, an incidence of SVD of 30% at 5 years was reported in one study 21 . A recent meta‐analysis by Ler et al 22 focussed on SVD including data from large multicentre trials. They report higher 1‐year, 2–3 years, and 5‐year rates of paravalvular regurgitation, moderate or severe aortic regurgitation, and reintervention in the TAVI group compared to SAVR.…”

Section: Discussionmentioning

confidence: 99%

Aortic valve replacement in patients over 60: Real‐world surgical outcomes

et al. 2021

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Objective With the advent of transcatheter aortic valve implantation (TAVI) has come an expectation that there will be a decline in surgical aortic valve replacement (SAVR). This has been fueled by trials comparing outcomes between TAVI and SAVR in lower‐risk patients. The aim of this study was to examine outcomes following SAVR in patients over the age of 60. Materials and Methods This retrospective cohort study observed 1005 patients ≥60 who underwent isolated primary SAVR from January 2015 to December 2018. The cohort was stratified by surgical risk, defined as European System for Cardiac Operative Risk Evaluation (EuroSCORE) II < 4 versus ≥4. The cohort was also divided by age (60–69, 70–79, ≥80) for additional comparisons. Outcomes included in‐hospital complications and patient survival. Results The median age and EuroSCORE II were 75 years and 1.6, respectively. The overall 30‐day mortality was 1.7% and increased significantly with surgical risk (p = .007). The 30‐day mortality of elective patients was 1.1%. Overall, 1‐ and 2‐year survival rates were 94.3% and 91.7%, respectively, which significantly decreased with surgical risk (p < .001) and age (p = .002, p = .003). The rates of postoperative stroke and pacemaker implantations were 1.2% and 3.6%, respectively. Conclusions SAVR can be performed in patients ≥60 years old with excellent outcomes, which compare favorably with outcomes from TAVI trials, with their highly selected patient cohorts. SAVR remains a reliable, tried and tested, treatment option in these patients.

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“…Long-term outcomes of the PARTNER 1 trial demonstrated similar all-cause mortality at 5-years follow-up for TAVR and SAVR (67.8 vs. 62.4%; P = 0.76) with higher rates of moderate or severe aortic regurgitation in the TAVR group compared to SAVR (14 vs. 1%; P < 0.0001), which was associated with increased 5-years risk of all-cause death in the TAVR group ( 44 ). A recent meta-analysis on structural durability of TAVR with both balloon-expandable and self-expanding valves vs. SAVR showed high rates of paravalvular regurgitation, moderate or severe aortic regurgitation, and reintervention at 5-years follow-up in the TAVR group compared to SAVR, thus highlighting that valve deterioration is still one of the open issues of percutaneous devices ( 45 ). Again, data were derived from trials using earlier generation TAVR valves in higher surgical risk ( 46 , 47 ).…”

Section: It Is Never Too Late To Be Young: Tavr In “Young” Patientsmentioning

confidence: 99%

Transcatheter Aortic Valve Replacement in Young Low-Risk Patients With Severe Aortic Stenosis: A Review

Bocchino

Angelini

Alushi

et al. 2020

Front. Cardiovasc. Med.

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In the last decades, transcatheter aortic valve replacement (TAVR) revolutionized the treatment of symptomatic severe aortic stenosis. The efficacy and safety of TAVR were first proven in inoperable and high-risk patients. Then, subsequent randomized clinical trials showed non-inferiority of TAVR as compared to surgical aortic valve replacement also in intermediate- and low-risk populations. As TAVR was progressively studied and clinically used in lower-risk patients, issues were raised questioning its opportunity in a younger population with a longer life-expectancy. As long-term follow-up data mainly derive from old studies with early generation devices on high or intermediate surgical risk patients, results can hardly be extended to most of currently treated patients who often show a low surgical risk and are treated with newer generation prostheses. Thus, in this low-risk younger population, decision making is difficult due to the lack of supporting data. The aim of the present review is to revise current literature regarding TAVR in younger patients.

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Structural durability of early-generation Transcatheter aortic valve replacement valves compared with surgical aortic valve replacement valves in heart valve surgery: a systematic review and meta-analysis

Cited by 18 publications

References 25 publications

Mid-term follow-up after aortic valve replacement with the Carpentier Edwards Magna Ease prosthesis

Mid-term follow-up after aortic valve replacement with the Carpentier Edwards Magna Ease prosthesis

Aortic valve replacement in patients over 60: Real‐world surgical outcomes

Transcatheter Aortic Valve Replacement in Young Low-Risk Patients With Severe Aortic Stenosis: A Review

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