Transcatheter aortic valve replacement (TAVR) for severe aortic stenosis

[tabs tab1=”2MM Rundown” tab2= “2MM Full Report”]

[tab]

Image: PD

1. The PARTNER B trial found improved 1 and 2 year mortality with TAVR compared to medical treatment for patients with severe symptomatic aortic stenosis who were not candidates for surgical aortic valve replacement (AVR).

2. The PARTNER A trial compared TAVR and AVR in high-risk surgical patients and found no difference in 1 or 2-year mortality, but higher rates of stroke and perivalvular leaks in the TAVR group.

3. A cost analysis of PARTNER B showed a mean cost of $78,542 per hospitalization, corresponding to $50,212 per life-year gained. 

Aortic stenosis is a valvular heart disease that increases in prevalence with age. Without intervention it is lethal, with a mortality of 75% at 3 years after onset of symptoms. Unfortunately, an estimated 30-40% of patients with severe aortic stenosis are denied surgery due to high risk of complications. In 2002, TAVR emerged as a less invasive option for valve repair. Results of the PARTNER B trial evaluating high-risk patients have supported TAVR improving mortality, while the PARTNER A trial for high-risk surgical patients demonstrated similar overall mortality but higher complication rates with TAVR. Complications include increased stroke rate in the periprocedural period and ongoing development of perivalvular leaks, which are associated with later strokes, endocarditis, hemolysis, and ongoing heart failure. TAVR is now undergoing evaluation for intermediate and low risk subgroups in the PARTNER II trial.

Click to read the study in The Journal of Thoracic and Cardiovascular Surgery

[/tab]

[tab]

1. The PARTNER B trial found improved 1 and 2 year mortality with TAVR compared to medical treatment for patients with severe symptomatic aortic stenosis who were not candidates for surgical aortic valve replacement (AVR).

2. The PARTNER A trial compared TAVR and AVR in high-risk surgical patients and found no difference in 1 or 2-year mortality, but higher rates of stroke and perivalvular leaks in the TAVR group.

3. A cost analysis of PARTNER B showed a mean cost of $78,542 per hospitalization, corresponding to $50,212 per life-year gained. 

This [randomized controlled] trial divided high risk surgical patients into those with and without transfemoral access, and randomized the transfemoral group to transfemoral TAVR versus AVR, and the group without access to transapical TAVR versus AVR. Among these patients, there was no difference in mortality but higher rates of neurologic events in the TAVR groups. Inoperable patients were randomized to transfemoral TAVR versus optimal medical therapy (those without transfemoral access were excluded). TAVR patients experienced a survival benefit at 1 and 2 years, but increased rates of perivalvular leaks.

In sum: Aortic stenosis is a valvular heart disease that increases in prevalence with age. Without intervention it is lethal, with a mortality of 75% at 3 years after onset of symptoms. Unfortunately, an estimated 30-40% of patients with severe aortic stenosis are denied surgery due to high risk of complications. In 2002, TAVR emerged as a less invasive option for valve repair. Results of the PARTNER B trial evaluating high-risk patients have supported TAVR improving mortality, while the PARTNER A trial for high-risk surgical patients demonstrated similar overall mortality but higher complication rates with TAVR. Complications include increased stroke rate in the periprocedural period and ongoing development of perivalvular leaks, which are associated with later strokes, endocarditis, hemolysis, and ongoing heart failure. TAVR is now undergoing evaluation for intermediate and low risk subgroups in the PARTNER II trial.

Click to read the study in The Journal of Thoracic and Cardiovascular Surgery

By Gina Siddiqui and Allen Ho

More from this author: PCI linked to higher rates of adverse events versus OPCAB, Mental stress-induced myocardial ischemia more common than exercise-induced

© 2013 2minutemedicine.com. All rights reserved. No works may be reproduced without written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT. Content is produced in accordance with fair use copyrights solely and strictly for the purpose of teaching, news and criticism. No benefit, monetary or otherwise, is realized by any participants or the owner of this domain.

[/tab]

[/tabs]