Michael J. Reardon, MD, professor of cardiothoracic surgery and Allison Family Distinguished chair of cardiovascular research at Houston Methodist DeBakey Heart and Vascular Center, presented pooled data at the American College of Cardiology (ACC) 2022 from the CoreValve SURTAVI trials that found transcatheter aortic valve replacement (TAVR) was more durable than surgical aortic valve replacement (SAVR) devices.
"For moderate and greater regurgitation patients, TAVR did better than surgery," Reardon said. "We know these TAVR valves have superior hemodynamics compared to surgical valves in every randomized trial and time point we tested. And this might be why surgery is behind the 8-ball when it begins, and why TAVR has a head start."
The study found patients who received a transcatheter supra-annular self-expanding heart valve had significantly less structural deterioration in the valve after five years than similar patients who had the valve inserted surgically. Overall, patients with structural valve deterioration (SVD) in their artificial valve were about twice as likely to die or need to be rehospitalized as those who did not.
The study is the largest to assess SVD in patients who participated in randomized trials comparing TAVR and SAVR and the first to show less structural valve deterioration after five years among patients treated with TAVR compared with SAVR, Reardon said.
Bioprosthetic valves have an average lifespan of about 15 years. In older patients whose life expectancy may be limited by age and other health problems, valve durability has been less of a concern, Reardon said. Previous studies suggest, however, that younger patients are at higher risk for SVD because their valves fail more quickly and because they have a longer potential life span. Previous studies have not clearly established whether the risk of SVD is higher with TAVR or with SAVR.
“Durability of the replacement valve becomes increasingly important in younger patients,” he said.
Reardon added they will also collect 10-year data on the intermediate- and low-risk trials to determine the valve deterioration level in these patients using TAVR and SAVR.
"We will get 10 year data in a lower risk, younger group of patients that are going to live longer and we are going to find out which valves last longer," he said.
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Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com