TAVR vs. surgery among children and young adults with congenital heart disease
Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are associated with similar short-term outcomes among pediatric patients presenting with congenital heart disease (CHD), according to new findings published in the American Journal of Cardiology.[1]
“Initially considered in adults who were thought to be high-risk surgical candidates, TAVR is now recognized as an alternative to SAVR, even among those at standard surgical risk,” wrote first author Dwight M. Robertson, DO, a pediatric cardiologist with Primary Children’s Hospital in Salt Lake City, and colleagues. “Our institution has gained experience with TAVR in the pediatric population and its associated outcomes, with the first institutional performance in 2014; we use it as an alternative to SAVR approaches in patients with standard surgical risk. The aims of this study were to describe our institutional experience with TAVR in the pediatric population and compare short-term outcomes between SAVR and TAVR in children and adolescents.”
Robertson et al. tracked data from 46 patients between the ages of 10 and 21 years old who underwent TAVR or SAVR from January 2010 to April 2020. Patients younger than 10 were not included, the team explained, because TAVR is “generally not an option in younger children” for multiple reasons.
While 30 of those 46 patients underwent SAVR, the other 16 underwent TAVR. Most (67%) SAVR patients received a bioprosthetic valve, and 17% underwent a pulmonary autograft/Ross procedure. Also, all TAVR patients included in this analysis were treated using a transfemoral approach.
“All patients in both groups had their procedures performed electively and the majority were outpatients before the procedure,” the authors added. “The most frequently documented indications for the procedure were moderate or severe aortic stenosis (AS), moderate or severe aortic regurgitation, dilated/hypertrophied left ventricles and exercise intolerance.”
Overall, after six months, patient outcomes were similar between the two treatment options. There was no difference in the study’s composite outcome (stroke within six months, hospital readmission within 30 days and death) between the two groups; it was seen in a total of three SAVR patients and 2 TAVR patients.
The median follow-up period was 3.8 years for SAVR patients and 1.5 years for TAVR patients. Reintervention was seen in 33% of SAVR patients and 38% of TAVR patients. The median time to reintervention was 4.7 years for SAVR patients and 2.5 years for TAVR patients.
SAVR patients did have “significantly” longer ICU stays and hospitalization times. They were also more likely to require medications to control their blood pressure following the procedure.
“Similar to previous studies, we found substantial use of bioprosthetic valves with SAVR in our patients, and overall increased usage of TAVR over time at our institution,” the authors wrote. “This is owing to incorporation of TAVR as an alternative to SAVR in patients with standard surgical risk as our experience with the procedure increased as opposed to early utilization in only those with high surgical risk.”
The team concluded by emphasizing the importance of long-term studies focused on this topic, especially when it comes to the use of TAVR among younger patients. Such information, they wrote, “will be useful as pediatric cardiologists and congenital cardiothoracic surgeons discuss options with their patients and allow a collaborative, informed decision regarding interventions for aortic valve disease.”
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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.