-
Views
-
Cite
Cite
David P Taggart, A paradigm shift from surgical to transcutaneous aortic valve replacement (PARTNER 3 and Evolut Low Risk trials), Cardiovascular Research, Volume 115, Issue 11, 1 September 2019, Pages e107–e108, https://doi.org/10.1093/cvr/cvz195
Close - Share Icon Share
Extract
Severe aortic stenosis is a relatively common clinical condition, becoming more common with advancing age, and the traditional treatment has been surgical aortic valve replacement (SAVR). Almost a decade ago transcutaneous aortic valve replacement (TAVR), was introduced as an alternative treatment to medical therapy alone in patients who were considered too high risk for conventional SAVR. A randomized trial published in 20101 showed a dramatic reduction in mortality at 1 year in these patients receiving TAVR in comparison to those only receiving medical therapy. One year later, it was reported that TAVR resulted in superior outcomes to SAVR in patients who were considered high risk but not ineligible for surgery.2 Approximately 5 years later, TAVR was shown to be at least equivalent to SAVR in patients who were intermediate risk for operation.3
In May 2019, two trials were published in the New England Journal of Medicine showing superior outcomes with TAVR than SAVR even in patients at low surgical risk. In one trial, the primary composite endpoint (death, stroke, or re-hospitalization at 1 year) occurred in 8.5% of patients undergoing TAVR vs. 15% undergoing SAVR.4 In the second trial, the primary composite endpoint (death or disabling stroke at 2 years) occurred in 5.3% of patients undergoing TAVR vs. 6.7% undergoing SAVR.5 In both studies, TAVR resulted in a trend towards reduced mortality at 1 year and 2 years, respectively and, crucially, also a significant reduction in disabling stroke. However, in both studies, there was a lower need for permanent pacemaker implantation with surgery. At follow-up, echocardiographic data showed excellent valve function for both TAVR and SAVR.
