Exploring the Role of Transcatheter Aortic Valve Replacement as the Preferred Treatment for Lower-Risk Patients

The investigators of the NOTION (Nordic Aortic Valve Intervention) trial showed that in an all-comers population of patients with severe aortic stenosis, transcatheter aortic valve replacement (TAVR) using the CoreValve self-expanding bioprosthesis (Medtronic Inc., Minneapolis, Minnesota) yielded similar rates of the composite endpoint of all-cause death, stroke, or myocardial infarction at 1 year compared with surgical bioprosthetic aortic valve replacement (1). Their study is the first to assess in a randomized trial the results of TAVR in a population including a high proportion of patients with low surgical risk (81.8% of patients). The scope of their findings paves the way toward the expanded use of TAVR, from extreme- to high-risk patients (2–5) to patients bearing lower surgical risks. However, the results of the primary analysis do not allow comment on the effects of TAVR among low-risk population. As the CoreValve trial taught (5), high-risk patients undergoing a self-expandable TAVR yield better outcomes (lower mortality) than with surgical bioprosthetic aortic valve replacement. It is likely that, among both groups of the NOTION trial, adverse events were concentrated in the minority of moderate- to high-risk patients, mirroring the results of the high-risk CoreValve trial. Consequently, clinical equipoise, with low event rates in both groups, is more than likely among their low-risk patient population. Although Thyregod et al. have to be commended for their pi...
Source: Journal of the American College of Cardiology: Cardiovascular Imaging - Category: Radiology Source Type: research