TAVR, SAVR produce similar long-term health gains

For patients with severe aortic stenosis (AS) at intermediate surgical risk, transcatheter aortic valve replacement (TAVR)—especially the transfemoral approach—might be a good solution.

New research indicates the long-term health benefits of TAVR in these patients are similar to those of surgical aortic valve replacement (SAVR). In addition, transfemoral TAVR was associated with greater one-month health status improvements when compared to SAVR, according to a study published in JAMA Cardiology.

However, at one and two years of follow-up time, there were no significant differences between TAVR or SAVR in any health status measures. Transthoracic TAVR showed similar health status improvements to SAVR at each stage of follow-up.

“Although the magnitude of long-term health status benefit was similar with TAVR and SAVR at 1 and 2 years, early health status benefits favored TAVR, but only among patients who were suitable for transfemoral access,” wrote the researchers, led by Suzanne J. Baron, MD, of St. Luke’s Mid America Heart Institute in Kansas City. “These results add to a growing literature demonstrating that TAVR via transthoracic access may not offer significant therapeutic advantages over SAVR.”

Baron and colleagues analyzed 1,833 AS patients—950 TAVR and 833 SAVR. The population was 54.9 percent men and its mean age was 81.4. All patients were considered to be at intermediate surgical risk with a predicted 30-day surgical mortality of 4 to 8 percent.

Health status was assessed at baseline, one month, one year and two years using the Kansas City Cardiomyopathy Questionnaire (KCCQ), which indicates a patient’s quality of life by evaluating five areas: physical function, social function, symptoms, quality of life and self-efficacy and knowledge. The individual scales are convertible into an overall summary score (KCCQ-OS), which is graded on a 0-100 scale. KCCQ-OS increases of five, 10 and 20 points correspond with small, moderate and large clinical improvements, respectively, according to the authors.

Regardless of which procedure was performed, the majority of the patients demonstrated at least moderate improvement by the end of the study.

“With more than 60 percent of surviving patients experiencing improvements of more than 10 points in the KCCQ-OS score at 2 years, these changes are not only statistically significant but also clinically meaningful, as prior studies in patients with heart failure have shown that improvements as small as 5 points on the KCCQ-OS are associated with reduced mortality and health care costs,” Baron and colleagues wrote.

The authors noted the proportion of patients who received TAVR via transthoracic access was small (24 percent), which may have limited their ability to compare health status in transthoracic TAVR patients with SAVR patients.

They also pointed out a third-generation TAVR device was made available following the trial, which used a second-generation device. It is unknown whether the newer-generation, balloon-expandable valve would have led to greater health status benefits, Baron and colleagues said.

“Further studies are needed to assess the durability of health status improvement of TAVR beyond 2 years and to understand the effects of third-generation TAVR devices on health status in patients with severe AS,” they wrote.