A NOTIONal truth : Surgical AVR deteriorates faster than TAVI, for some mysterious reasons!

Conclusion The study results finds the valve deployed percutaneously under semi- blind vision, was equipoise with SAVR done under direct vision. The surprise however is, TAVI was superior to cardiac surgeons in multiple aspects .The mysterious finding is TAVI had less Structural valve dysfunction, and possibly low bio valvular failure (BVF), if Kaplan -Myer curve trend is little extrapolated. No doubt ,the Aortic interventional world is applauding and everyone is joining the party. Now, some academic queries ? 1.Did the trial compared best practices of TAVI & SAVR ? No. Because it was done in 2010-2013. (Which grew faster TAVI or SAVR in the last10 years ? in terms of both hardware and expertise . How it will impact now ?) 2..Was the outcome assessment blinded ? No 3.Why there is 50 % cardio vascular and 60% all cause mortality in both groups even though they belong to low risk category ? Don’t know. Not clear. 4.Why the gradient was high in SAVR in the follow up ? There are two important factors. More than 98% of TAVI patients had a valve sized 26–31 mm, while 98% of SAVR patients received a size 19–25 mm . Apart from valve size aortic annular enlargement before SAVR was not done in majority, there by enhancing the gradient and valve mis-match.(Note :The TAVI begins at 26mm and SAVR ends at 25mm. For how many of you this looks odd ?) 4a. Was doppler velocity index measured in all to assess EOA in follow up ? No. It w...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Uncategorized acc aha esc guidlines aortic stenosis Aortic valve replacement avr core valve edward sapien notion 10 year follow up notion trial partner savr st judes valve surtavi tavi tavr in low risk category uk tavi Source Type: blogs