Transcatheter versus optimal medical treatment and surgical aortic valve replacement for aortic valve stenosis

Thyregod, Hans G.H.; Möller, Christian; Søndergaard, Lars; Gluud, Christian

doi:10.1002/14651858.cd010488

Cited by 3 publications

(2 citation statements)

References 80 publications

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“…The 1-year results of the NOTION trial, in low-risk patients, showed a rate of moderate or more AR of 15.7% and 0.9% after TAVI and SAVR, respectively, which persisted at 5 years 22. While moderate and severe AR is clearly associated with increased mortality rates, studies on the impact of mild paravalvular regurgitation (PVR) on outcomes have yielded conflicting results.…”

Section: What Are the Remaining Challenges For Tavi In Low-risk Patiementioning

confidence: 99%

Transcatheter aortic valve implantation in low-risk patients: is it too early?

Sousa-Uva

2019

Heart

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The median age of patients treated by transcatheter aortic valve implantation (TAVI) is falling across Europe, and low-risk patients with severe aortic stenosis (AS) represent 80% of patients with severe AS undergoing surgical aortic valve replacement (SAVR). There are few data for TAVI in low-risk patients, but there are four ongoing randomised trials of SAVR versus TAVI. The key issues relate to pacemaker implantation rates and the associated potential longer term deleterious effects, and the need to minimise vascular complications and paravalvular leak. Valve leaflet thrombosis and paucity of data on valve durability remain a concern. Given the higher incidence of bicuspid aortic valves in younger patients, outcomes of TAVI in this setting need clarification and are discussed.

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Section: What Are the Remaining Challenges For Tavi In Low-risk Patiementioning

confidence: 99%

Transcatheter aortic valve implantation in low-risk patients: is it too early?

Sousa-Uva

2019

Heart

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“…The American-run PARTNER trials were the first large-scale, international randomized controlled trials (RCTs) for TAVI. They continue to provide landmark evidence, particularly relating to morbidity and mortality outcomes of TAVI relative to AVR, supporting the use of TAVI 2,3 . Many international RCTs have been conducted in TAVI, with primary outcome measures typically focusing on clinical effectiveness compared with AVR, 4 economic efficiency, 5 morbidity measures such as disabling stroke, 6 midterm and long-term outcomes, 7 and outcome prediction 8 .…”

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confidence: 99%

Is Transcatheter Aortic Valve Implantation Effective in Improving Quality of Life?

et al. 2023

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Background: Aortic stenosis (AS) without surgical intervention is associated with morbidity and mortality and is the most common valvular disease in the western world. Transcatheter aortic valve implantation (TAVI) is a minimally invasive surgical option that has become a common treatment for people unable to undergo open aortic valve replacement; despite the increase in TAVI offerings in the last decade, patient quality of life (QoL) outcomes postoperatively are poorly understood. Objective: The aim of this review was to determine whether TAVI is effective in improving QoL. Method: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted, and the protocol was registered on PROSPERO (CRD42019122753). MEDLINE, CINAHL, EMBASE, and PsycINFO were searched for studies published between 2008 and 2021. Search terms included "transcatheter aortic valve replacement" and "quality of life" and their synonyms. Included studies were evaluated, dependent on study design, using either the Risk of Bias-2 or the Newcastle-Ottawa Scale. Seventy studies were included in the review. Results: Authors of the studies used a wide variety of QoL assessment instruments and follow-up durations; authors of most studies identified an improvement in QoL, and a small number identified a decline in QoL or no change from baseline. Conclusion: Although authors of the vast majority of studies identified an improvement in QoL, there was very little consistency in instrument choice or follow-up duration; this made analysis and comparison difficult. A consistent approach to measuring QoL for patients who undergo TAVI is needed to enable comparison of outcomes. A richer, more nuanced understanding of QoL outcomes after TAVI could help clinicians support patient decision making and evaluate outcomes.

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