Transcatheter aortic valve replacement valve durability: Good enough for young, low-risk patients?

Edelman, James; Shults, Christian; Thourani, Vinod H.

doi:10.1016/j.jtcvs.2019.05.089

Cited by 8 publications

(6 citation statements)

References 32 publications

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“…Ironically, the major TAVR trials are the first to provide core-laboratory adjudicated, perprotocol (rather than per-symptom) follow-up of surgical bioprostheses! 11 We agree about the detrimental long-term effects of both paravalvular regurgitation and new permanent pacemaker implantation. However, in the PARTNER 3 trial, there was no difference in pacemaker rates up to 1 year between TAVR and SAVR, 6,8 and the rates of paravalvular regurgitation have significantly reduced over the past couple of years with third-and fourth-generation TAVR devices.…”

Section: Aortic Stenosismentioning

confidence: 67%

Commentary: American Heart Association/American College of Cardiology Valve guidelines: Starting point for discussion by the heart team or dictum?

Edelman

Thourani

2021

The Journal of Thoracic and Cardiovascular Surgery

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Section: Aortic Stenosismentioning

confidence: 67%

Commentary: American Heart Association/American College of Cardiology Valve guidelines: Starting point for discussion by the heart team or dictum?

Edelman

Thourani

2021

The Journal of Thoracic and Cardiovascular Surgery

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“…Available data do not show any concerning signals for early valvular degeneration, but include only elderly patients not expected to outlive their surgical prosthesis. 52 There are limitations also for the data of SAVR bioprosthesis durability, mainly a paucity of prospective, protocolized echocardiographic follow-up. The best durability data may emerge from the planned 10-year follow-up of the low-and intermediate-risk randomized trials comparing TAVR and SAVR.…”

Section: Areas Of Uncertainty and Consensus Discussionmentioning

confidence: 99%

The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies

Thourani¹,

Edelman

Holmes

et al. 2021

Innovations�(Phila)

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Objective There is an increasing amount of evidence supporting use of transcatheter aortic valve replacement (TAVR) for treatment of aortic stenosis in patients at low or intermediate risk for surgical aortic valve replacement (SAVR). TAVR is now approved for use in all patient cohorts. Despite this, there remains debate about the relative efficacy of TAVR compared with SAVR in lower-risk cohorts and various subgroups of patients. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and propensity-matched trials to guide a consensus among expert cardiologists and surgeons. Methods Studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a thorough search of the major databases. Mortality, stroke, and other perioperative outcomes were assessed at 30 days and 1 year. Results Early mortality was lower in TAVR compared to SAVR in RCTs, but not propensity-matched studies in low-risk cohorts (0.66% vs 1.5%; odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20 to 0.98, I2 = 0%). No difference in mortality between TAVR and SAVR was identified in intermediate-risk patients at early or later time points. Incidence of perioperative stroke in 3 low-risk RCTs was significantly lower in TAVR (0.4%) than SAVR (1.4%; OR = 0.33, 95% CI 0.13 to 0.81, I2 = 0%). There was no difference in stroke for intermediate-risk patients between TAVR and SAVR. The expert panel of cardiologists and cardiac surgeons provided recommendations for TAVR and SAVR in various clinical scenarios. Conclusions In RCTs comparing TAVR and SAVR in low-risk patients, early mortality and stroke were lower in TAVR, but did not differ at 1 year. There was no difference in mortality and stroke in intermediate-risk patients. The Multidisciplinary Heart Team must consider individual patient characteristics and preferences when recommending TAVR or SAVR. The decision must consider the long-term management of each patient’s aortic valve disease.

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“…Others have found primary TAVR valve durability in elderly populations similar to that of surgical valves at 5 years. 14 , 15 Whether these trends continue, are replicated in low-risk patients, and are replicated in the ViV setting is not known.…”

Section: Surgerymentioning

confidence: 99%

Transcatheter aortic valve replacement valve-in-valve: Future implications for the surgeon

Steffen

Bapat

2022

JTCVS Open

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Transcatheter aortic valve replacement valve durability: Good enough for young, low-risk patients?

Cited by 8 publications

References 32 publications

Commentary: American Heart Association/American College of Cardiology Valve guidelines: Starting point for discussion by the heart team or dictum?

Commentary: American Heart Association/American College of Cardiology Valve guidelines: Starting point for discussion by the heart team or dictum?

The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies

Transcatheter aortic valve replacement valve-in-valve: Future implications for the surgeon

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