TAVR and SAVR deliver similar outcomes for patients with low-flow, low-gradient aortic stenosis
Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are associated with comparable patient outcomes when patients present with low-flow, low-gradient (LFLG) aortic stenosis, according to new data published in The Journal of Thoracic and Cardiovascular Surgery.[1]
“The optimal type of intervention in LFLG aortic stenosis remains undetermined,” wrote first author James A. Brown, MD, MS, a cardiothoracic surgery resident with the University of Pittsburgh, and colleagues. “TAVR avoids myocardial dysfunction from cardiopulmonary bypass and may have a larger bioprosthetic effective orifice area than SAVR, while SAVR has lower rates of paravalvular leak (PVL) and conduction disturbances, both of which adversely affect left ventricular function. Moreover, the relative durability of SAVR and TAVR prostheses remains uncertain, and surgery allows for concomitant procedures, including aortic root enlargement, coronary artery bypass grafting and mitral valve interventions.”
Brown et al. tracked data from nearly 248 low-risk patients who underwent first-time aortic valve replacement for LFLG aortic stenosis at a single high-volume medical center. While 52.8% of those patients underwent SAVR, the other 47.2% underwent TAVR. The median follow-up period was 3.6 years. TAVR patients were significantly older than SAVR patients at baseline.
Overall, 30-day mortality, stroke and pacemaker rates were comparable between the TAVR and SAVR patients. PVL was more common after TAVR, as one may expect. After one year, there was no significant difference in aortic valve mean gradient or ejection fraction (EF).
The authors added that, after a multivariable analysis, neither treatment option was associated with an increased risk of mortality or heart failure readmission.
“These results correspond to the findings of the PARTNER study, supporting real clinical equipoise,” the authors wrote. “Nevertheless, even though this study is the largest with the longest median follow-up, it is also possible that this study had insufficient sample size or inadequate follow-up and was therefore underpowered to detect differences. Whatever the optimal treatment, both groups had improved EF and reduced mean aortic transvalvular pressure gradient, with reasonable short-term mortality and long-term survival.”
The group added that longer “larger prospective randomized studies with longer follow-up” are still necessary to help “establish guidelines for the use of TAVR and SAVR in LFLG.”
Click here for the full analysis.
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.