When heart patients can’t wait: Urgent TAVR with self-expanding vs. balloon-expandable valves
Self-expanding valves (SEVs) and balloon-expandable valves (BEVs) are associated with comparable long-term survival rates when used for urgent and emergent transcatheter aortic valve replacement (TAVR) procedures, according to new data published in the International Journal of Cardiology.[1]
“Considering urgent TAVR for a decompensated patient is a higher-risk procedure compared to elective TAVR, meticulous preprocedural planning is crucial for better results, and valve selection is one of the required steps,” wrote first author Anastasios Apostolos, MD, MSc, PhD, a researcher with Harefield Hospital in England, and colleagues. “Numerous randomized controlled trials and meta-analyses have compared SEVs and BEVs showing similar efficacy and safety. Nevertheless, evidence regarding their comparative use in the context of urgent TAVR for patients admitted with decompensated heart failure remains absent, even though both valve platforms are routinely deployed in such patients.”
To learn more, Apostolos et al. explored data from nearly 600 patients who underwent urgent or emergent TAVR at one of two high-volume facilities from 2012 to 2024. Urgent TAVR was defined as cases where the patient was not specifically hospitalized to undergo TAVR, but they require TAVR before they can be discharged. Examples include patients admitted for sudden chest pain or acute myocardial infarction. Emergent TAVR was defined as cases when the patient requires TAVR within 24 hours due to life-threatening conditions. Examples include patients with cardiogenic shock or refractory pulmonary edema. For the sake of this analysis, the group used the term “urgent TAVR” to cover both urgent and emergent cases.
All SEV patients received a Medtronic transcatheter heart valve. All BEV patients received an Edwards Lifesciences transcatheter heart valve. Overall, an adjusted Cox regression found no significant difference in long-term mortality between these two valve types. Patients from the BEV group were linked to a higher technical success rate, higher device success rate and a reduced risk of in-hospital mortality. However, when focused on the 299 patients who received a contemporary transcatheter heart valve, there were no longer any significant differences.
“The observed differences in outcomes between the total cohort and the contemporary transcatheter heart valve subgroup can be explained primarily by generational advancements in transcatheter heart valve design, particularly for SEV,” the authors wrote. “The 12-year inclusion period includes significant evolution in TAVR technology, device iterations, and operator experience.”
The group added that pre-TAVR mitral regurgitation stood out as an independent predictor of long-term mortality in their research. This was also true for the contemporary cohort.
“These findings underscore the potential benefit of staged or combined valvular interventions, such as mitral transcatheter edge-to-edge repair, to improve survival and quality of life in patients with severe pre-TAVR mitral regurgitation,” they wrote.
Click here to read the full analysis in the International Journal of Cardiology, a publication of the International Society for Adult Congenital Heart Disease.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.