Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Valve Stenosis

Thyregod, Hans Gustav Hørsted; Steinbrüchel, Daniel A.; Ihlemann, Nikolaj; Nissen, Henrik; Kjeldsen, Bo Juel; Pétursson, Pétur; Chang, Yao-Chuan; Franzen, Olaf; Engstrøm, Thomas; Clemmensen, Peter; Hansen, Per Brinch; Andersen, Lars Willy; Olsen, Peter Skov; Søndergaard, Lars

doi:10.1016/j.jacc.2015.03.014

Cited by 814 publications

(432 citation statements)

References 31 publications

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“…We directly compared TAVR and SAVR and found an almost 90% increased risk of ischemic stroke with TAVR compared with SAVR, and more than 6‐fold increased risk of hemorrhagic stroke. The Nordic Aortic Valve Intervention Trial showed no difference in stroke or transient ischemic attack at 30 days or 1 year in patients undergoing TAVR versus SAVR, regardless of predicted risk of death following surgery 17. Similarly, the PARTNER (Placement of Aortic Transcatheter Valves) 2 Trial showed no difference in stroke risk in intermediate‐risk patients at 30 days and 1 year 5, 18.…”

Section: Discussionmentioning

confidence: 99%

Intermediate‐Term Risk of Stroke Following Cardiac Procedures in a Nationally Representative Data Set

Stein

Thaler

Liang

et al. 2017

JAHA

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BackgroundStudies on stroke risk following cardiac procedures addressed only perioperative and long‐term risk following limited higher‐risk procedures, were poorly generalizable, and often failed to stratify by stroke type. We calculated stroke risk in the intermediate risk period following cardiac procedures compared with common noncardiac surgeries and medical admissions.Methods and ResultsThe Nationwide Readmissions Database contains readmission data for 49% of US admissions in 2013. We compared age‐adjusted stroke readmission rates up to 90 days postdischarge. We used Cox regression to calculate hazard ratios, up to 1 year, of stroke risk comparing transcatheter aortic valve replacement versus surgical aortic valve replacement and coronary artery bypass graft versus percutaneous coronary intervention. Procedures and diagnoses were identified by International Classification of Disease, Ninth Revision, Clinical Modification codes. After cardiac procedures, 90‐day ischemic stroke readmission rate was highest after transcatheter aortic valve replacement (2.05%); 90‐day hemorrhagic stroke rate was highest after left ventricular assist device placement (0.09%). The hazard ratio for ischemic stroke after transcatheter aortic valve replacement, compared with surgical aortic valve replacement, in fully adjusted Cox models was 1.86 (95% confidence interval, 1.12–3.08; P=0.016) and 6.17 (95% confidence interval, 1.97–19.33; P=0.0018) for hemorrhagic stroke. There was no difference between coronary artery bypass graft and percutaneous coronary intervention.ConclusionsWe demonstrated elevated readmission rates for ischemic and hemorrhagic stroke in the intermediate 30‐, 60‐, and 90‐day risk periods following common cardiac procedures. Furthermore, we found an elevated risk of stroke after transcatheter aortic valve replacement compared with surgical aortic valve replacement up to 1 year.

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Section: Discussionmentioning

confidence: 99%

Intermediate‐Term Risk of Stroke Following Cardiac Procedures in a Nationally Representative Data Set

Stein

Thaler

Liang

et al. 2017

JAHA

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“…Observational studies in Europe were the first to suggest that TAVR is safe in low‐ and intermediate‐risk patients, with low rates of procedural complications and short‐term mortality,6, 7, 8, 9 although a recent meta‐analysis suggested increased intermediate‐term mortality with TAVR compared with SAVR (relative risk 1.45, 95% confidence interval, 1.11–1.89, P =0.006) with median follow‐up of 2 years 10. More robust data were provided by the NOTION (Nordic Aortic Valve Intervention Trial), which randomized primarily low‐risk patients to SAVR versus TAVR with the self‐expanding CoreValve THV (Medtronic, Minneapolis, MN) 11. There were no differences between groups in 2‐year mortality or composite outcome of all‐cause mortality, stroke, or myocardial infarction (Tables 1 and 2).…”

Section: Clinical Trials In Operable Patientsmentioning

confidence: 99%

Transcatheter Aortic Valve Replacement in Intermediate‐ and Low‐Risk Patients

Rogers

Thourani

Waksman

2018

JAHA

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“…Similar positive results have been demonstrated also in low-risk AS population. In the Nordic Aortic Valve Intervention Trial (NOTION), Thyregod et al [30] randomized 280 low-risk AS patients to TAVI or SAVR. The primary endpoint of death for any causes, myocardial infarction and stroke after 1 year was observed in 13.1% of the TAVI group and 16.3% of the SAVR group.…”

Section: Intermediate and Low Risk Patientsmentioning

confidence: 99%

Who is the next for aortic valve implantation? Present and future indications

Verolino¹,

Veneri²,

Carpenito³

et al. 2018

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Aortic valve stenosis (AS) represents the most prevalent valvular defect worldwide. It is a progressive disease with a long latency interval and a poor prognosis after symptoms present. According to current European Society of Cardiology guidelines, transcatheter aortic valve implantation (TAVI) is recommended in all patients with severe symptomatic AS and a predicted survival longer than one year, who are not suitable for surgical valve replacement. Despite these recommendations, several studies over the past few years suggest extending these indications towards lower risk AS populations. Otherwise, current available operative risk scores such as Society of Thoracic Surgeons score and EuroSCORE, may offer an incomplete risk assessment; in this setting, the Heart Team plays a crucial role in defining the most appropriate therapeutic strategy in patients with AS. In this review, we aim to discuss the current and future indications for TAVI, analyzing available literature according to patients' profile risk (high/mid/low risk) and other specific conditions (valve-in-valve, bicuspid valve and pure aortic regurgitation).

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Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Valve Stenosis

Cited by 814 publications

References 31 publications

Intermediate‐Term Risk of Stroke Following Cardiac Procedures in a Nationally Representative Data Set

Intermediate‐Term Risk of Stroke Following Cardiac Procedures in a Nationally Representative Data Set

Transcatheter Aortic Valve Replacement in Intermediate‐ and Low‐Risk Patients

Who is the next for aortic valve implantation? Present and future indications

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