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Maze Y, Tokui T, Narukawa T, Murakami M, Yamaguchi D, Inoue R, Hirano K, Takamura T, Nakamura K, Seko T, Kasai A, Ito H. Left ventricular mass and valve performance after surgical and transcatheter aortic valve replacement: a single-center experience from Japan. Cardiovasc Diagn Ther 2023; 13:805-818. [PMID: 37941847 PMCID: PMC10628418 DOI: 10.21037/cdt-23-119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/31/2023] [Indexed: 11/10/2023]
Abstract
Background There are few reports on the postoperative left ventricular mass (LVM), aortic valve area (AVA), and pressure gradient (PG) after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) in Japan. We aimed to compare the postoperative LVM, AVA, stroke volume (SV), PG, and long-term outcomes between patients undergoing SAVR and TAVR procedures from single center in Japan. Methods This was a retrospective cohort study. We included 107 patients who underwent simple SAVR between January 2012 and May 2022 (SAVR group, n=107) and 274 who underwent TAVR between January 2016 and May 2022 (TAVR group, n=274). The overall mean follow-up periods was 28.8±25.9 months (median: 24 months; range, 0.03-117 months). Results The aortic valve mean PG (mmHg) was significantly smaller in the TAVR group than in the SAVR group (P<0.001). The AVA index (cm2/m2) was significantly larger in the TAVR group than in the SAVR group (P<0.001). The SV index (mL/m2) was significantly smaller in the SAVR group than in the TAVR group (P=0.02). The LVM index (LVMI) (g/m2) was significantly smaller in the SAVR group than in the TAVR group (P<0.001). The incidence of mild or higher postoperative paravalvular leak (PVL) and pacemaker implantation were significantly higher in the TAVR group. The 5-year postoperative mortality, re-hospitalization, and major adverse cerebral and cardiovascular events (MACCEs) were significantly better in the SAVR group. Conclusions The postoperative aortic valve PG, AVA, and SV were better in the TAVR group; however, LVM regression and postoperative outcomes were better in the SAVR group.
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Affiliation(s)
- Yasumi Maze
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan
| | - Toshiya Tokui
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan
| | - Takahiro Narukawa
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan
| | - Masahiko Murakami
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan
| | - Daisuke Yamaguchi
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan
| | - Ryosai Inoue
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan
| | - Koji Hirano
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan
| | | | - Kenji Nakamura
- Department of Cardiology, Ise Red Cross Hospital, Ise, Japan
| | - Tetsuya Seko
- Department of Cardiology, Ise Red Cross Hospital, Ise, Japan
| | - Atsunobu Kasai
- Department of Cardiology, Ise Red Cross Hospital, Ise, Japan
| | - Hisato Ito
- Department of Thoracic and Cardiovascular Surgery, Mie University Hospital, Tsu, Japan
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Stehli J, Zaman S, Stähli BE. Sex discrepancies in pathophysiology, presentation, treatment, and outcomes of severe aortic stenosis. Front Cardiovasc Med 2023; 10:1256970. [PMID: 37649667 PMCID: PMC10465161 DOI: 10.3389/fcvm.2023.1256970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/28/2023] [Indexed: 09/01/2023] Open
Abstract
This review gives an overview of sex-based differences in aortic valve stenosis, spanning from pathophysiological mechanisms and disease progression, clinical presentation, presence of comorbidities, and diagnostic assessment, to treatment and outcomes. In particular, sex-related differences in the degree of aortic valve calcification, the response of the left ventricle to pressure overload, as well as in the referral to procedures, with women being less frequently referred for surgical aortic valve replacement and experiencing longer waiting times for transcatheter procedures, will be discussed. Sex-related differences are also particularly evident in outcomes of patients with severe aortic stenosis undergoing surgical or transcatheter procedures. The apparent sex paradox seen in women undergoing transcatheter aortic valve implantation refers to the phenomenon of women experiencing higher rates of short-term mortality and bleeding events, but demonstrating improved long-term survival as compared to men. Women who undergo surgical aortic valve replacement have generally worse outcomes as compared to men, which is reflected by the inclusion of female sex in surgical risk calculation scores. Hence, a thorough understanding of sex-related differences in aortic valve stenosis is important to provide optimal and personalized patient care.
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Affiliation(s)
- Julia Stehli
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Barbara E. Stähli
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Ion AC, Serbanoiu LI, Plesu E, Busnatu SS, Andrei CL. Transcatheter Aortic Valve Replacement vs. Surgical Aortic Valve Replacement for Long-Term Mortality Due to Stroke and Myocardial Infarction: A Meta-Analysis during the COVID-19 Pandemic. Medicina (B Aires) 2022; 59. [PMID: 36676636 DOI: 10.3390/medicina59010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Background and objectives: One of the leading causes of mortality and morbidity in people over the age of 50 is stroke. The acceptance of transcatheter aortic valve replacement (TAVR) as a treatment option for severe symptomatic aortic stenosis (AS) has increased as a result of numerous randomized clinical trials comparing surgical aortic valve replacement (SAVR) and TAVR in high- and intermediate-risk patients, showing comparable clinical outcomes and valve hemodynamics. Materials and Methods: An electronic search of Medline, Google Scholar and Cochrane Central was carried out from their inception to 28 September 2022 without any language restrictions. Results: Our meta-analysis demonstrated that, as compared with SAVR, TAVR was not linked with a lower stroke ratio or stroke mortality. It is clear from this that the SAVR intervention techniques applied in the six studies were successful in reducing cardiogenic consequences over time. Conclusions: A significantly decreased rate of mortality from cardiogenic causes was associated with SAVR. Additionally, when TAVR and SAVR were compared for stroke mortality, the results were nonsignificant with a p value of 0.57, indicating that none of these procedures could decrease stroke-related mortality.
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Chatfield AG, Cheung A, Akodad M, Chuang A, Besola L, Sellers S, Wood DA, Sathananthan J, Webb J. Transcatheter solutions for transcatheter aortic valve replacement dysfunction: is redo transcatheter aortic valve replacement a durable option? Ann Cardiothorac Surg 2021; 10:571-584. [PMID: 34733686 DOI: 10.21037/acs-2021-tviv-85] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/18/2021] [Indexed: 11/06/2022]
Abstract
As transcatheter aortic valve replacement (TAVR) expands into a younger and lower risk cohort of patients, many important clinical questions are raised, including the one of overall valve durability. Bioprosthetic valve dysfunction (BVD) is a complex clinical issue, of which structural valve deterioration (SVD) is a subcategory. Similar to surgical bioprosthesis, transcatheter heart valves (THVs) can fail over the years however, data on long-term THVs durability is lacking, especially in the lower risk cohort. Surgical explant with open aortic surgery or a second THV, described as redo-TAVR, are feasible options when the first THV fails. However long-term data in these patients is even more limited. Important clinical considerations such as the mechanism(s) of THV dysfunction, the type and timing of the second procedure must be carefully considered. There are also inherently important clinical concerns regarding redo-TAVR, such as coronary access and higher post procedure gradients. In the present keynote lecture, we review the diagnosis of THV dysfunction and transcatheter options available when SVD occurs.
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Affiliation(s)
- Andrew G Chatfield
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Anson Cheung
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Mariama Akodad
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Anthony Chuang
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Laura Besola
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie Sellers
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - David A Wood
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John Webb
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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Henning RJ. The current diagnosis and treatment of patients with aortic valve stenosis. Future Cardiol 2021; 17:1143-1160. [PMID: 33728942 DOI: 10.2217/fca-2020-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aortic valve stenosis (AS) is the third most frequent cardiovascular abnormality after coronary artery disease and hypertension. A bicuspid aortic valve is the most common cause for AS until seventh decade and calcific valve degeneration is responsible thereafter. In symptomatic patients, The risk of death increases from ≤1%/year to 2%/month. An echo valve area ≤1 cm2, peak transaortic velocity ≥4 m/s, mean valve gradient ≥40 mmHg and/or computerized tomography valve calcium score >2000 Agatston units (AU) for males or more than 1200 AU for females indicate severe AS. AS stages and management are discussed. Valve replacement is based on surgical risk, valve durability/hemodynamics, need for anticoagulation and patient preferences. EuroSCORE ≥20%, Society of Thoracic Surgeons Predicted Risk of Mortality ≥8% and co-morbidities indicate high surgical risk. Surgery is recommended for low-intermediate risk patients. Transcatheter aortic valve implantation is an alternative in older patients at low, intermediate, high or prohibitive risk. Transaortic valve implantation/replacement trials are summarized.
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Tamagnini G, Bourguignon T, Rega F, Verbrugghe P, Lamberigts M, Langenaeken T, Meuris B. Device profile of the Inspiris Resilia valve for aortic valve replacement: overview of its safety and efficacy. Expert Rev Med Devices 2021; 18:239-244. [PMID: 33583313 DOI: 10.1080/17434440.2021.1886921] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The Inspiris Resilia tissue valve was recently introduced into clinical practice. This review summarizes the pre-clinical and clinical studies leading to this new bioprosthesis. AREAS COVERED The novel Resilia tissue was tested extensively in a large animal model. The clinical use of the tissue started in 2011 with the European Feasibility study, followed by a North-American multi-center study. Since 2017, the Inspiris Resilia valve has been in full commercial use. Further prospective evaluations and registries are ongoing. EXPERT OPINION The Inspiris Resilia valve was clinically introduced after pre-clinical tests revealed superiority compared to contemporary therapy such as the Perimount valve. Prospective long-term follow-up studies on Resilia are ongoing since 2011 and reveal no major complications. Full 5-year data show no signs of early degeneration, but longer follow-up is certainly still needed. Several prospective registries are actively monitoring the outcome with the Inspiris Resilia valve now. The novel tissue, designed to mitigate calcification and increase durability, together with the expandable stent, facilitating potential future valve-in-valve (ViV) procedures, are the cutting-edge aspects. Clinical use in younger patients is currently ongoing: their follow-up and outcome will determine the added value of this valve.
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Affiliation(s)
- G Tamagnini
- Department of Cardiovascular Surgery -, Villa Torri Hospital, GVM Care&Research, Bologna, Italy
| | - T Bourguignon
- Department of Cardiac Surgery, Tours University Hospital, Tours, France
| | - F Rega
- Department of Cardiovascular Diseases, Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - P Verbrugghe
- Department of Cardiovascular Diseases, Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - M Lamberigts
- Department of Cardiovascular Diseases, Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - T Langenaeken
- Department of Cardiovascular Diseases, Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meuris
- Department of Cardiovascular Diseases, Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
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Abstract
The management of aortic stenosis has been revolutionized by transcatheter aortic valve replacement (TAVR). Initially only undertaken in patients at prohibitive or high surgical risk, as the evidence base and indications have expanded, TAVR is now approved and undertaken in patients at all risk levels. Evolution of valve technology, delivery systems and pathways for patient work-up have been rapid, with associated reductions in the complication profile, particularly vascular complications. Challenges remain as TAVR continues to advance, however, specifically achieving further reduction in paravalvular regurgitation, the requirement for permanent pacemaker implantation, and balancing the risks of thrombosis and bleeding. In this review, we outline the historical advances leading to contemporary TAVR practice, and discuss the future trajectory.
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Affiliation(s)
- Thomas J Cahill
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Juan A Terre
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Isaac George
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
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8
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Carrel T, Heinisch PP. History, development and clinical perspectives of sutureless and rapid deployment surgical aortic valve replacement. Ann Cardiothorac Surg 2020; 9:375-385. [PMID: 33102176 DOI: 10.21037/acs-2020-surd-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Degenerative aortic stenosis is the most frequent valvular heart disease in industrialized countries. Conservative treatment may beneficially influence symptoms but is never successful. Surgical aortic valve replacement (SAVR) was the only recognized treatment option to provide substantially prolonged survival until 2008. Operative mortality of isolated SAVR has been reported as low as 0.5% to 1% in experienced institutions, while long-term survival is close to that observed in a control healthy population of similar age. A multitude of studies have demonstrated the beneficial effects of SAVR with regard to improvement in quality of life and physical performance in the majority of symptomatic patients. In the last decade, transcatheter aortic valve implantation (TAVI) has emerged as an equal treatment modality, first in patients with high surgical risk and more recently in patients with intermediate and low surgical risk. Paravalvular regurgitation and the higher rate of pacemaker implantation remain points of consideration. Additionally, the long-term durability of TAVI devices and occurrence of stroke late after TAVI require additional analyses. Sutureless (SU-SAVR) and rapid deployment valve (R-SAVR) were designed to simplify and accelerate a conventional or less invasive surgical procedure while allowing complete excision of the calcified native valve. From 3 different implants tested more than 10 to 15 years ago, only two are available on the market today: the Perceval® valve from Liva Nova and the Intuity® sutureless prosthesis from Edwards Lifesciences. There has been extensive experience with these two devices in previous years and the results obtained are comparable to those observed following the use of conventional implants. The sutureless devices may be of particular interest for more complex and combined surgical procedures. This review summarizes the sutureless (SU-SAVR) and rapid deployment valve technologies and presents a clinical outlook for the patient population managed with these devices.
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Affiliation(s)
- Thierry Carrel
- Department for Cardiovascular Surgery, University Hospital and University of Bern, Bern, Switzerland
| | - Paul Philipp Heinisch
- Department for Cardiovascular Surgery, University Hospital and University of Bern, Bern, Switzerland
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Caponcello MG, Banderas LM, Ferrero C, Bramlage C, Thoenes M, Bramlage P. Gender differences in aortic valve replacement: is surgical aortic valve replacement riskier and transcatheter aortic valve replacement safer in women than in men? J Thorac Dis 2020; 12:3737-3746. [PMID: 32802453 PMCID: PMC7399394 DOI: 10.21037/jtd-20-700] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Aortic stenosis (AS) is a progressive and degenerative disease that necessitates valve replacement through either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Various studies have shown that, unlike for TAVR, SAVR is associated with an elevated risk for women as compared to men. The aim of this review is to better understand the risks and their possible causes, associated with the use of both TAVR and SAVR in female patients. Our systematic review included studies published between 2012 and 2020, identified through specific searches of PubMed. Compatibility of publications, determined by the use of pre-defined inclusion/exclusion criteria, resulted in 15 articles being used in our review. Overall, more men than women undergo SAVR, but our findings confirmed that SAVR is associated with worse outcomes in women in the short-term. Reasons for a higher 30-day mortality post-SAVR in women include an increased age, higher in-hospital mortality and, possibly baseline comorbidities and anatomical differences. There was no difference observed in 30-day mortality between men and women undergoing TAVR. Female patients appear to have a better longer-term survival post-TAVR than their male counterparts. Understanding the reasons why women have worse outcomes post-SAVR is essential for ensuring appropriate treatment selection for patients with AS, as well as for achieving the best possible long-term and safety outcomes for these patients.
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Affiliation(s)
- Maria Giulia Caponcello
- Departamento Farmacia y Tecnología Farmacéutica, Universidad de Sevilla, Sevilla, Spain.,Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Lucia M Banderas
- Departamento Farmacia y Tecnología Farmacéutica, Universidad de Sevilla, Sevilla, Spain
| | - Carmen Ferrero
- Departamento Farmacia y Tecnología Farmacéutica, Universidad de Sevilla, Sevilla, Spain
| | - Carsten Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Martin Thoenes
- Departamento Farmacia y Tecnología Farmacéutica, Universidad de Sevilla, Sevilla, Spain.,Leman Research Institute, Switzerland
| | - Peter Bramlage
- Departamento Farmacia y Tecnología Farmacéutica, Universidad de Sevilla, Sevilla, Spain.,Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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Khan MR, Kayani WT, Manan M, Munir A, Hamzeh I, Virani SS, Birnbaum Y, Jneid H, Alam M. Comparison of surgical versus transcatheter aortic valve replacement for patients with aortic stenosis at low-intermediate risk. Cardiovasc Diagn Ther 2020; 10:135-144. [PMID: 32420093 DOI: 10.21037/cdt.2020.02.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background To compare safety and efficacy of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) in patients at low-intermediate risk, given the paucity of robust data. Methods We performed an aggregate data meta-analysis of 7 randomized controlled trials (RCTs) and 6,778 patients comparing TAVR with SAVR for aortic stenosis (AS) in low-intermediate risk patients (Society of Thoracic Surgeons risk-score ≤8%) using the random-effects model. Primary outcome was all-cause mortality at 30-day, 1-year and 2-year of follow-up. Secondary outcomes included cardiac-mortality, stroke, acute kidney injury (AKI), atrial fibrillation (AF), permanent pacemaker (PPM) implantation, major-bleeding, moderate-severe paravalvular regurgitation (PVR) and rehospitalization. Results All-cause mortality, cardiac-mortality and stroke were comparable between the two groups. AF was higher with SAVR at 30-day [odds ratio (OR) 0.17, 95% confidence intervals (CI): 0.12-0.24] thorough to 2-year (OR 0.34, 95% CI: 0.21-0.55), while PPM implantation was higher with TAVR (30-day: OR 3.31, 95% CI: 1.64-6.66, 2-year: OR 3.17, 95% CI: 1.02-9.86). Moderate-severe PVR was more prevalent with TAVR at all follow-ups. On inter-group comparison, patients in the low-risk group had an even lower risk of AF, but a higher risk of PPM implantation as compared to the patients in the intermediate-risk group undergoing TAVR. Conclusions Compared to SAVR, TAVR had comparable all-cause mortality and stroke, lower-risk of AF, but was associated with a higher risk of PPM implantation and moderate-severe PVR in low-intermediate-risk patients. Thus, highlighting the need for longer-term follow-up before robust inferences are drawn.
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Affiliation(s)
- Mahin R Khan
- Division of Cardiology, McLaren-Flint/Michigan State University, Flint, MI, USA
| | - Waleed T Kayani
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Ahmad Munir
- Division of Cardiology, McLaren-Flint/Michigan State University, Flint, MI, USA
| | - Ihab Hamzeh
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Salim S Virani
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Yochai Birnbaum
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hani Jneid
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Mahboob Alam
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
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11
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Braghiroli J, Kapoor K, Thielhelm TP, Ferreira T, Cohen MG. Transcatheter aortic valve replacement in low risk patients: a review of PARTNER 3 and Evolut low risk trials. Cardiovasc Diagn Ther 2020; 10:59-71. [PMID: 32175228 DOI: 10.21037/cdt.2019.09.12] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a mainstay in treatment for patients with severe aortic stenosis who are considered high-risk surgical candidates. The use of TAVR in low-risk patients with severe aortic stenosis is being explored as an alternative to surgical aortic valve replacement (SAVR). Recent results from the Medtronic Evolut Low Risk trial and the Placement of Aortic Transcatheter Valves (PARTNER) 3 trial shed light on the use of TAVR in low-risk surgical candidates. The Evolut Low Risk trial compared TAVR with a self-expanding supra-annular bioprosthesis to SAVR in 1468 patients with severe aortic stenosis who were low surgical risk. Patients with a mean age of 74 and a mean Society of Thoracic Surgeons (STS) risk score of 1.9% were randomized to either TAVR or SAVR groups. Using the composite end point of death or disabling stroke at 24 months, the study found an incidence of 5.3% in the TAVR arm and 6.7% in the surgical arm. The Evolut Low Risk trial thus concluded that TAVR was statistically noninferior but not superior to SAVR (difference, -1.4 percentage points; 95% Bayesian credible interval for the difference, -4.9 to 2.1; posterior probability of noninferiority, >0.999). The PARTNER 3 trial assigned 1,000 patients with severe aortic stenosis and low surgical risk to either TAVR with transfemoral placement of balloon expandable valve or SAVR. Patients with a mean age of 73 and a mean STS score of 1.9% were randomized to either TAVR or SAVR groups. With respect to the primary endpoint of composite death from any cause, stroke, or rehospitalization, the study found an occurrence of 8.5% in TAVR and 15.1% in SAVR, confirming both noninferiority and superiority in the TAVR group [absolute difference, -6.6 percentage points; 95% confidence interval (CI), -10.8 to -2.5; P<0.001 for noninferiority; hazard ratio, 0.54; 95% CI, 0.37 to 0.79; P=0.001 for superiority]. Both the Evolut low risk trial and the PARTNER 3 trial provide evidence that the use of TAVR extends beyond the scope of high and intermediate risk surgical patients and is at the very least equivalent to SAVR in the treatment low-risk surgical candidates when using a transfemoral approach in patients without bicuspid aortic valves. In this article we provide an extensive review on the Evolute low risk and PARTNER 3 trials, including a discussion on clinically relevant outcomes.
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Affiliation(s)
- Joao Braghiroli
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Kunal Kapoor
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Torin P Thielhelm
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Tanira Ferreira
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Mauricio G Cohen
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
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12
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Fu J, Popal MS, Li Y, Li G, Qi Y, Fang F, Kwong JSW, You B, Meng X, Du J. Transcatheter versus surgical aortic valve replacement in low and intermediate risk patients with severe aortic stenosis: systematic review and meta-analysis of randomized controlled trials and propensity score matching observational studies. J Thorac Dis 2019; 11:1945-1962. [PMID: 31285888 DOI: 10.21037/jtd.2019.04.97] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background To compare the outcome of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) in low and intermediate risk patients with severe aortic stenosis (AS). Randomized controlled trials (RCT) and propensity score matching (PSM) studies compare TAVR with SAVR in patients at low and intermediate surgical risk. Methods Two authors searched relevant literature independently, then extracted data from the included studies, and assessed risk of bias and quality of study separately according to different study designs, besides that, the extracted data was analyzed via utilization of GRADE system to evaluate the quality of evidence separately. Results Overall 15 studies (5 RCTs, 10 PSM studies) with total 12,057 patients were selected. Mortality and disabling stroke during follow-up period were comparable between TAVR and SAVR (RR 1.09, 95% CI: 0.81 to 1.46; RR 0.7, 95% CI: 0.45 to 1.07, respectively), TAVR revealed to be superior to SAVR regarding acute kidney injury (AKI), and onset of new atrial fibrillation (AF) (RCT: high certainty; AKI in PSM: moderate certainty, AF in PSM: low certainty). These results of RCT and PSM studies are consistent. In RCT review, SAVR was better in the following aspects: aortic valve (AV) re-intervention (high certainty), vascular complications, pacemaker implantation (moderate certainty), but comparable in the following aspects: myocardial infarction (MI), aortic insufficient (AI) (moderate certainty), major bleeding (low certainty). In PSM review, SAVR revealed a better result in AI and vascular complications (high certainty), but in the aspects of AV re-intervention, pacemaker implantation, major bleeding and MI (low certainty), it was comparable. Conclusions TAVR is comparable to SAVR in terms of mortality and disabling stroke in severe AS patients at low and intermediate risk, but higher proportion of AV re-intervention observed in TAVR. Those results should encourage caution when extending the indications of TAVR into low risk patients, especially for young low risk patients. Systematic review registration PROSPERO CRD 42018112626.
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Affiliation(s)
- Jintao Fu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Yulin Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guoqi Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yue Qi
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fang Fang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Joey S W Kwong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Bin You
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Meng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Du
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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13
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Mäkikallio T, Jalava MP, Husso A, Virtanen M, Laakso T, Ahvenvaara T, Tauriainen T, Maaranen P, Kinnunen EM, Dahlbacka S, Jaakkola J, Airaksinen J, Anttila V, Savontaus M, Laine M, Juvonen T, Valtola A, Raivio P, Eskola M, Niemelä M, Biancari F. Ten-year experience with transcatheter and surgical aortic valve replacement in Finland. Ann Med 2019; 51:270-279. [PMID: 31112060 PMCID: PMC7880078 DOI: 10.1080/07853890.2019.1614657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Aim: We investigated the outcomes of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in Finland during the last decade. Methods: The nationwide FinnValve registry included data from 6463 patients who underwent TAVR or SAVR with a bioprosthesis for aortic stenosis from 2008 to 2017. Results: The annual number of treated patients increased three-fold during the study period. Thirty-day mortality declined from 4.8% to 1.2% for TAVR (p = .011) and from 4.1% to 1.8% for SAVR (p = .048). Two-year survival improved from 71.4% to 83.9% for TAVR (p < .001) and from 87.2% to 91.6% for SAVR (p = .006). During the study period, a significant reduction in moderate-to-severe paravalvular regurgitation was observed among TAVR patients and a reduction of the rate of acute kidney injury was observed among both SAVR and TAVR patients. Similarly, the rate of red blood cell transfusion and severe bleeding decreased significantly among SAVR and TAVR patients. Hospital stay declined from 10.4 ± 8.4 to 3.7 ± 3.4 days after TAVR (p < .001) and from 9.0 ± 5.9 to 7.8 ± 5.1 days after SAVR (p < .001). Conclusions: In Finland, the introduction of TAVR has led to an increase in the invasive treatment of severe aortic stenosis, which was accompanied by improved early outcomes after both SAVR and TAVR. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03385915 Key Messages This study demonstrated that the introduction of transcatheter aortic valve replacement has led to its widespread use as an invasive treatment for severe aortic stenosis. Early and 2-year survival after transcatheter and surgical aortic valve replacement has improved during past decade. Transcatheter aortic valve replacement has fulfilled its previously unmet clinical needs and has surpassed surgical aortic valve replacement as the most common invasive treatment for aortic stenosis.
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Affiliation(s)
- Timo Mäkikallio
- a Department of Internal Medicine , Oulu University Hospital , Oulu , Finland
| | - Maina P Jalava
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | | | - Marko Virtanen
- d Heart Hospital , Tampere University Hospital , Tampere , Finland
| | - Teemu Laakso
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Tuomas Ahvenvaara
- f Department of Surgery , Oulu University Hospital and University of Oulu , Finland
| | - Tuomas Tauriainen
- f Department of Surgery , Oulu University Hospital and University of Oulu , Finland
| | - Pasi Maaranen
- d Heart Hospital , Tampere University Hospital , Tampere , Finland
| | | | | | - Jussi Jaakkola
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Juhani Airaksinen
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Vesa Anttila
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Mikko Savontaus
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Mika Laine
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Tatu Juvonen
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Antti Valtola
- c Heart Center , Kuopio University Hospital , Kuopio , Finland
| | - Peter Raivio
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Markku Eskola
- d Heart Hospital , Tampere University Hospital , Tampere , Finland
| | - Matti Niemelä
- a Department of Internal Medicine , Oulu University Hospital , Oulu , Finland
| | - Fausto Biancari
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland.,f Department of Surgery , Oulu University Hospital and University of Oulu , Finland.,g Department of Surgery , University of Turku, Turku , Finland
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14
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Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as the standard treatment option for patients with symptomatic aortic stenosis who are considered intermediate to high surgical risk. Nonetheless, optimal clinical outcomes following the procedure require careful consideration of procedural risk by the Heart Team. While this decision-making could be supported through the development of TAVI-specific clinical prediction models (CPMs), current models remain suboptimal. In this review paper, we aimed to outline the performance of several recently derived TAVI CPMs that predict mortality and present some future research directions. We discuss how the existing risk models have achieved only moderate discrimination but highlight that some of the models are well calibrated across multiple populations, indicating the feasibility of using them to aid benchmarking analyses. Moreover, we suggest that future work should focus on the development of CPMs in cohorts of patients with aortic stenosis that include multiple treatment modalities. Supported by appropriate modelling of 'what if' scenarios, this would allow the Heart Teams to predict and compare outcomes across surgical aortic valve replacement, medical management and TAVI, thereby allowing one to personalise treatment decisions to the individual patient. Such a goal could be facilitated by considering novel risk factors, shifting the focus to endpoints other than mortality, and through collaborative efforts to combine the evidence base and existing models across wider populations.
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Affiliation(s)
- Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Matthew Sperrin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
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15
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Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as the gold standard technique for all patients with symptomatic severe aortic stenosis at elevated surgical risk. Much progress has been made to reduce procedural complications and improve patient outcomes. The impressive results of contemporary TAVI can be attributed to a variety of factors, including improving operator experience, pre-operative patient screening, and developments in transcatheter heart valve and delivery system technology. Despite these advances, serious procedural complications continue to occur and there remain some anatomical subsets and patient groups to whom TAVI technology has not been expanded. Herein we discuss these unmet needs in TAVI.
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Affiliation(s)
- Antoinette Neylon
- Department of Cardiology, University Hospital of Galway, Newcastle Road, Galway, Ireland
| | - Khalid Ahmed
- Department of Cardiology, University Hospital of Galway, Newcastle Road, Galway, Ireland
| | - Federico Mercanti
- Department of Cardiology, University Hospital of Galway, Newcastle Road, Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, University Hospital of Galway, Newcastle Road, Galway, Ireland.,National University of Ireland, Galway, Ireland
| | - Darren Mylotte
- Department of Cardiology, University Hospital of Galway, Newcastle Road, Galway, Ireland.,National University of Ireland, Galway, Ireland
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16
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Shehada SE, Wendt D, Peters D, Mourad F, Marx P, Thielmann M, Kahlert P, Lind A, Janosi RA, Rassaf T, Rath PM, Thoenes M, Jakob H, El Gabry M. Infections after transcatheter versus surgical aortic valve replacement: mid-term results of 200 consecutive patients. J Thorac Dis 2018; 10:4342-4352. [PMID: 30174882 DOI: 10.21037/jtd.2018.06.54] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Transcatheter aortic valve implantation (TAVI) is the standard therapy for high-risk patients with aortic stenosis (AS). TAVI-outcomes are widely investigated in comparison to surgical aortic valve replacement (SAVR), but less is known about infectious complications after TAVI. We aimed to compare early and mid-term infectious outcomes of patients undergoing TAVI or SAVR. Methods The present study is a prospective single-centre study including 200 consecutive patients between 06/2014-03/2015 undergoing TAVI (either transfemoral or transapical and transaortic, n=47+53=100) or SAVR (either isolated or concomitant with CABG, n=52+48=100). The mean age and log. EuroSCORE were significantly different between both groups (81±6 versus 69±11 years, P<0.001 and 23.1%±13.8% versus 8.7%±9.5%, P<0.001). Primary endpoints included wound healing disorders, respiratory and urinary tract infections and incidence of endocarditis or sepsis within hospital stay. Secondary endpoints included infectious parameters, infectious related rehospitalisation and 2-year mortality. Results Primary endpoints showed no difference in overall TAVI- versus SAVR-groups regarding respiratory- (14% versus 19%, P=0.45), urinary-tract (7% versus 4%, P=0.54) infections, sepsis (5% versus 6%, P=1.0), endocarditis (0% versus 1%, P=1.0) or 30-day mortality (10% versus 4%, P=0.09), except for wound disorders, which were significantly lower in the TAVI-group (1% versus 8%, P=0.035), respectively. Secondary endpoints reported no difference regarding infectious related rehospitalisation (4% versus 4%, P=1.0), but significantly higher 2-year mortality (28% versus 16%, P=0.048) in the TAVI-group. Conclusions So far, little has been studied about infectious complications after TAVI. This study reports no difference between the overall TAVI and SAVR groups regarding infectious complications. However, SAVR group show more wound healing disorders but less mortality than TAVI group.
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Affiliation(s)
- Sharaf-Eldin Shehada
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Davina Peters
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Fanar Mourad
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Philipp Marx
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Philipp Kahlert
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Alexander Lind
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Rolf-Alexander Janosi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Peter-Michael Rath
- Institute for Medical Microbiology, University Hospital Essen, Essen, Germany
| | | | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Mohamed El Gabry
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
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17
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Abstract
Transcatheter aortic valve implantation (TAVI) or replacement (TAVR) was recently approved by the FDA for intermediate risk patients with severe aortic stenosis (AS). This technique was already worldwide adopted for inoperable and high-risk patients. Improved device technology, imaging analysis and operator expertise has reduced the initial worrisome higher complications rate associated with TAVR, making it comparable to surgical aortic valve replacement (SAVR). However, many answers need to be addressed before adoption in lower risk patients. This paper highlights the pros and cons of TAVI based mostly on randomized clinical trials involving the two device platforms approved in the United States. We focused our analysis on metrics that will play a key role in expanding TAVR indication in healthier individuals. We review the significance and gave a perspective on paravalvular leak (PVL), valve performance, valve durability, leaflet thrombosis, stroke and pacemaker requirement.
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Affiliation(s)
- Juan A Terré
- New York Presbyterian Hospital-Columbia University Medical Center, New York, NY, USA
| | - Isaac George
- New York Presbyterian Hospital-Columbia University Medical Center, New York, NY, USA
| | - Craig R Smith
- New York Presbyterian Hospital-Columbia University Medical Center, New York, NY, USA
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18
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Musa TA, Plein S, Greenwood JP. The role of cardiovascular magnetic resonance in the assessment of severe aortic stenosis and in post-procedural evaluation following transcatheter aortic valve implantation and surgical aortic valve replacement. Quant Imaging Med Surg 2016; 6:259-73. [PMID: 27429910 DOI: 10.21037/qims.2016.06.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Degenerative aortic stenosis (AS) is the most common valvular disease in the western world with a prevalence expected to double within the next 50 years. International guidelines advocate the use of cardiovascular magnetic resonance (CMR) as an investigative tool, both to guide diagnosis and to direct optimal treatment. CMR is the reference standard for quantifying both left and right ventricular volumes and mass, which is essential to assess the impact of AS upon global cardiac function. Given the ability to image any structure in any plane, CMR offers many other diagnostic strengths including full visualisation of valvular morphology, direct planimetry of orifice area, the quantification of stenotic jets and in particular, accurate quantification of valvular regurgitation. In addition, CMR permits reliable and accurate measurements of the aortic root and arch which can be fundamental to appropriate patient management. There is a growing evidence base to indicate tissue characterisation using CMR provides prognostic information, both in asymptomatic AS patients and those undergoing intervention. Furthermore, a number of current clinical trials will likely raise the importance of CMR in routine patient management. This article will focus on the incremental value of CMR in the assessment of severe AS and the insights it offers following valve replacement.
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Affiliation(s)
- Tarique Al Musa
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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19
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Arora S, Misenheimer JA, Jones W, Bahekar A, Caughey M, Ramm CJ, Caranasos TG, Yeung M, Vavalle JP. Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis. Cardiovasc Diagn Ther 2016; 6:241-9. [PMID: 27280087 DOI: 10.21037/cdt.2016.03.04] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has been approved in patients with high or prohibited surgical risk for surgery for treatment of severe symptomatic aortic stenosis. Prospective studies examining the benefits of TAVR in intermediate risk patients are ongoing. Other smaller studies including lower risk patients have been conducted, but further meta-analysis of these studies is required to draw more broad comparisons. METHODS A Medline search was conducted using standard methodology to search for clinical trials and observational studies including intermediate risk patients. We limited our meta-analysis to studies matching patient populations by propensity scores or randomization and examined clinical outcomes between TAVR and surgical aortic valve replacement (SAVR). RESULTS Analysis of the TAVR and SAVR cohorts revealed no significant differences in the outcomes of 30-day [OR (95% CI): 0.85 (0.57, 1.26)] or 1-year mortality [OR (95% CI): 0.96 (0.75, 1.23)]. A trend towards benefit with TAVR was noted in terms of neurological events and myocardial infarction (MI) without statistical significance. A statistically significant decrease in risk of post-procedural acute renal failure in the TAVR group [OR (95% CI): 0.52 (0.27, 0.99)] was observed, but so was a significantly higher rate of pacemaker implantations for the TAVR group [OR (95% CI): 6.51 (3.23, 13.12)]. CONCLUSIONS We conclude that in intermediate risk patients undergoing aortic valve replacement, the risk of mortality, neurological outcomes, and MI do not appear to be significantly different between TAVR and SAVR. However, there appears to be a significant reduction in risk of acute renal failure at the expense of an increased risk of requiring a permanent pacemaker in low and intermediate risk patients undergoing TAVR compared to SAVR.
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Affiliation(s)
- Sameer Arora
- 1 Campbell University School of Osteopathic Medicine, Lillington, NC, USA ; 2 Cape Fear Valley Medical Center, Fayetteville, NC, USA ; 3 University of North Carolina, Chapel Hill, NC, USA
| | - Jacob A Misenheimer
- 1 Campbell University School of Osteopathic Medicine, Lillington, NC, USA ; 2 Cape Fear Valley Medical Center, Fayetteville, NC, USA ; 3 University of North Carolina, Chapel Hill, NC, USA
| | - Wesley Jones
- 1 Campbell University School of Osteopathic Medicine, Lillington, NC, USA ; 2 Cape Fear Valley Medical Center, Fayetteville, NC, USA ; 3 University of North Carolina, Chapel Hill, NC, USA
| | - Amol Bahekar
- 1 Campbell University School of Osteopathic Medicine, Lillington, NC, USA ; 2 Cape Fear Valley Medical Center, Fayetteville, NC, USA ; 3 University of North Carolina, Chapel Hill, NC, USA
| | - Melissa Caughey
- 1 Campbell University School of Osteopathic Medicine, Lillington, NC, USA ; 2 Cape Fear Valley Medical Center, Fayetteville, NC, USA ; 3 University of North Carolina, Chapel Hill, NC, USA
| | - Cassandra J Ramm
- 1 Campbell University School of Osteopathic Medicine, Lillington, NC, USA ; 2 Cape Fear Valley Medical Center, Fayetteville, NC, USA ; 3 University of North Carolina, Chapel Hill, NC, USA
| | - Thomas G Caranasos
- 1 Campbell University School of Osteopathic Medicine, Lillington, NC, USA ; 2 Cape Fear Valley Medical Center, Fayetteville, NC, USA ; 3 University of North Carolina, Chapel Hill, NC, USA
| | - Michael Yeung
- 1 Campbell University School of Osteopathic Medicine, Lillington, NC, USA ; 2 Cape Fear Valley Medical Center, Fayetteville, NC, USA ; 3 University of North Carolina, Chapel Hill, NC, USA
| | - John P Vavalle
- 1 Campbell University School of Osteopathic Medicine, Lillington, NC, USA ; 2 Cape Fear Valley Medical Center, Fayetteville, NC, USA ; 3 University of North Carolina, Chapel Hill, NC, USA
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