How valve type and anesthesia strategy affect 1-year TAVR outcomes
As transcatheter aortic valve replacement (TAVR) continues to gain popularity, researchers all over the world are working to learn as much as possible about how to boost outcomes while still delivering high-quality care.
One team out of Germany, for example, explored how the care team’s heart valve of choice and anesthesia strategy may affect one-year outcomes, publishing their findings in the Journal of the American College of Cardiology.
“Newer-generation transcatheter heart valves aimed to overcome limitations of earlier-generation devices, including large access sheath size, high rate of permanent pacemaker implantation, and paravalvular leakage,” wrote lead author Hans-Josef Feistritzer, MD, PhD, of the Leipzig Heart Institute in Germany, and colleagues. “Growing heart team experience and technical improvements of valve designs and delivery systems also resulted in an increasing number of transfemoral TAVR procedures performed with local anesthesia with conscious sedation (CS) instead of general anesthesia (GA). Nonrandomized studies reported lower short-term mortality with CS compared with GA. However, randomized trials were lacking so far.”
Feistritzer et al. studied one-year data from the SOLVE-TATI trial, which included 447 patients who presented with symptomatic aortic stenosis at one of seven sites in Germany. All patients were treated between April 2016 and April 2018. While approximately half of the group were treated with a newer-generation self-expanding valve (SEV), the remaining patients were treated with a newer-generation balloon-expandable valve (BEV). Approximately half of the group was also treated with CS, with the others being treated with GA.
When comparing the two valve types, the team found that the combined endpoint of all-cause mortality, stroke, moderate or severe paravalvular leakage and permanent pacemaker implantation was similar between the two groups.
On a similar note, the combined endpoint of all-cause mortality, stroke, myocardial infarction and acute kidney injury were similar between the CS and GA groups. The stroke rate was slightly higher after one year for the GA patient group, but it wasn’t a big enough difference to be viewed as statistically significant.
Looking ahead, Feistritzer and colleagues noted that there is still plenty of work to be done in this area of TAVR research.
“Randomized trials are needed to directly compare different valve types and anesthesia strategies in patient categories defined based on specific risk characteristics,” the authors wrote.
Read the team’s full evaluation here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.