TAVR vs. SAVR for low-risk patients: Cardiologist explores the decision-making process
Transcatheter aortic valve replacement (TAVR) was initially seen as an effective alternative to surgical aortic valve replacement (SAVR) in patients who were elderly or faced a heightened risk of surgical complications, but it is now being considered more and more for low-risk patients.
Interventional cardiologist Jose G. Diez, MD, an associate professor at Baylor College of Medicine, commented on this ongoing trend in a new editorial published by The American Journal of Cardiology.[1]
In his commentary, Diez noted that TAVR and SAVR have been linked to comparable outcomes in multiple clinical trials. However, he said, cardiologists and the rest of the heart team should still weigh all options when considering TAVR in a low-risk patient. He emphasized the importance of both heart teams and shared decision-making when it comes to choosing the right treatment option for an individual patient.
“While the durability of transcatheter valves remains and important element that warrants further observation, the available evidence supports its implementation in the low-surgical risk cohort,” he added.
Key things to remember when considering TAVR for a low-risk patient
According to Diez, heart teams should keep certain patient factors in mind whenever TAVR is a treatment option. If the patient is 60 years old or younger, for example, reintervention procedures such as valve-in-valve TAVR become much more likely. Patients who present with a history of congenital heart disease may also be a better candidate for SAVR due to “limited evidence” on the long-term impact these conditions may have on TAVR outcomes.
TAVR is also linked to higher rates of certain complications than SAVR, including patient-prosthesis mismatch and paravalvular leak. For some patients, these added risks may be enough for the heart team to choose surgery over TAVR.
“While the expansion of TAVR to low-risk patients represents a significant shift in the management of severe aortic stenosis, providing a less invasive option to SAVR, with good short- and medium-term outcomes, it is important to consider long-term durability and the potential need for future re-interventions when choosing TAVR for younger patients or those with longer life expectancies,” he concluded. “Overall, the choice between TAVR and SAVR should be individualized, taking into account patient-specific factors such as anatomical suitability, comorbid conditions, and patient preferences.”
Read the full commentary, “The high stakes of performing transcatheter aortic valve replacement in the low surgical risk patient,” 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.