Rethinking SAVR in the TAVR era: New Cleveland Clinic study explores data from nearly 3,500 patients
Surgical aortic valve replacement (SAVR) may be even safer than popular risk models suggest, according to a new analysis published in the Journal of Thoracic and Cardiovascular Surgery.[1] This finding, researchers noted, is one that specialists should keep in mind when choosing between SAVR, transcatheter aortic valve replacement (TAVR) and other treatment options.
A team of cardiologists and cardiac surgeons from Cleveland Clinic examined data from 3,493 low-risk adult patients who underwent SAVR at a single high-volume facility from January 2005 to January 2017. The mean patient age at the time of SAVR was 65 years old, mean preoperative aortic valve area was 0.77 cm2 and mean preoperative gradient was 47 Hg. Patients who underwent other cardiac procedures at the same time were excluded from the team’s findings.
Overall, the mortality rate immediately following SAVR was 0.43%, which is considerably lower than the 1.6% estimated at the time by Society of Thoracic Surgeons (STS) risk models. In addition, researchers noted, mortality steadily declined over time.
“The outcomes we observed improved over time while the expected risk remained flat,” senior author Lars Svensson, MD, PhD, chair of Cleveland Clinic’s Miller Family Heart, Vascular and Thoracic Institute, explained in a post on the Cleveland Clinic Consult QD website.
Svensson et al. also found that post-SAVR survival was 98% after one year, 91% after five years and 82% after nine years.
“These survival rates are superior to those for the general U.S. population when matched for age, race and sex,” Svensson said. “They illustrate a durability of benefit that lends support for early intervention and can serve as a valuable comparator as data accumulates on the durability of TAVR in younger patients.”
The Cleveland Clinic specialists also shared another key takeaway from their research: updated risk models are needed to help care teams and patients alike gain a better understanding of the risks associated with these treatments.
“Optimal counseling on the most appropriate valve therapy for individual patients requires continuously updated risk models that reflect state-of-the-art care,” Svensson said. “Patients deserve to know not only what a typical outcome is, but also what is potentially achievable to minimize their risk.”
“In the current era when many centers are offering aortic valve replacements, including SAVR and TAVR, it is important for patients to have benchmark data like these from high-volume excellent operators, to inform them of their treatment options,” added cardiologist and well-known TAVR researcher Samir Kapadia, MD, chair of the department of cardiovascular medicine at Cleveland Clinic. “Although randomized trials provide comparative data, there is tremendous variability in outcomes and patient selection among different U.S. centers. It is important for patients to understand these differences before making treatment choices.”
Read the full study 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.