Beyond PARTNER: Appraising the Evolving Trends and Outcomes in Transcatheter Aortic Valve Replacement
Transcatheter aortic valve replacement (TAVR) has become the preferred treatment in patients with symptomatic severe aortic stenosis deemed to be at prohibitive or high risk for surgical aortic valve replacement. With evolving technology, improving practices and patient selection, outcomes in TAVR have improved. In the not so distant future, TAVR may become an alternative to surgical aortic valve replacement even for patients who are not at high risk for open surgery. However, issues such as stroke, paravalvular leak and pacemaker need remain, and the unknown limitations of TAVR, including durability and undefined options for reintervention for prosthesis dysfunction, must be addressed before this therapy can be extended to younger, lower risk patients.
ConclusionBased on this summary of available observational data TAVR for PAR is feasible and safe in patients deemed inoperable. First-generation TAVR devices are associated with inferior outcome and should be avoided. The “on-label” use of PAR-certified TAVR devices is associated with a significantly higher procedural success rate and might be favorable compared to other second-generation devices.
Purpose of review Transcatheter aortic valve replacement (TAVR) has become the cornerstone for aortic valve intervention since the first implantation in 2002. Recent advances with novel devices and introduction into lower risk cohorts have been successful. In this review, we discuss the ongoing limitations to transcatheter aortic valve therapy and whether it will replace surgical aortic valve replacement in the foreseeable future. Recent findings A better understanding of valve durability, high-grade heart block, and stroke post TAVR has led to practice changes that improve patient outcome. Summary Although there h...
CONCLUSIONS: Urgent minimalist TAVR can be safely performed with favorable in-hospital outcomes, while increased 30-day and 1-year mortality rates suggest the importance of appropriate diagnosis and timely treatment of severe aortic stenosis. PMID: 30700628 [PubMed - in process]
Ove the last decade, transcatheter aortic valve replacement (TAVR) has emerged as the recommended approach over surgical aortic valve replacement (SAVR) for many patients with aortic stenosis. While initial trials demonstrated a higher incidence of stroke with TAVR compared to SAVR, the incidence of stroke appears to have improved over time. With the increasing number of patients expected to undergo TAVR in the coming decades, it is important to review the incidence and etiology of stroke after SAVR and TAVR.
ConclusionsConcomitant CABG at the time of AVR was performed without increasing early- or mid-term mortality. This absence of increased risk deserves consideration when choosing between different treatment strategies.
ConclusionsPRBC transfusion in patients undergoing TAVR is associated with an increased incidence of adverse outcomes during hospitalization, at 30-day and 1-year follow-up.
Authors: Del Val D, Ferreira-Neto AN, Asmarats L, Maes F, Guimaraes L, Junquera L, Wintzer J, Fischer Q, Barroso de Freitas Ferraz A, Puri R, Rodés-Cabau J Abstract INTRODUCTION: Transcatheter aortic valve replacement (TAVR) is a well-established treatment for patients with severe aortic stenosis and intermediate-to-high surgical risk. The increasing clinical experience along with technical and design iterations of transcatheter valve systems have contributed to reducing adverse events and improving clinical outcomes. Areas covered: Overview of the latest generation transcatheter heart valves (THVs), focusin...
CONCLUSIONS: PRBC transfusion in patients undergoing TAVR is associated with an increased incidence of adverse outcomes during hospitalization, at 30-day and 1-year follow-up. PMID: 30552884 [PubMed - as supplied by publisher]
Authors: Bakelants E, Belmans A, Verbrugghe P, Adriaenssens T, Jacobs S, Bennett J, Meuris B, Desmet W, Rega F, Herijgers P, Herregods MC, Dubois CL Abstract AIMS: Transcatheter aortic valve implantation (TAVI) is the preferred treatment modality for patients with severe aortic stenosis at high or prohibitive risk for surgical aortic valve replacement (SAVR). We aimed to evaluate real-world outcomes after treatment according to the decisions of the multidisciplinary heart team in a Belgian health-economic context. METHODS AND RESULTS: Four hundred and five high-risk patients referred to a tertiary centre betwee...
CONCLUSIONS: In our patient cohort, 9.5% of patients who underwent TAVR had concomitant aortic aneurysms. Patients with aortic aneurysms had similar incidence of vascular complications as well as in-hospital and 6-month MACE compared to those without. PMID: 30595280 [PubMed - in process]