TAVR Reduces Heart Valve Replacement Mortality

A new study confirms that elderly aortic stenosis patients once considered too frail or too sick for a standard valve replacement are living longer thanks to transcatheter aortic valve replacement (TAVR).

Researchers at the Cleveland Clinic (OH, USA), Emory University (Atlanta, GA, USA) and other institutions reported the five-year outcomes of the placement of aortic transcatheter valves (PARTNER) trial, part of which compared TAVR with surgical aortic valve replacement (SAVR) in high-risk patients with aortic stenosis. The randomized controlled trial was held at 25 hospitals in Canada, Germany, and the USA, with the primary outcome being all-cause mortality in the intention-to-treat population.

The 358 study participants (mean age 83 years), were evenly assigned to TAVR or standard SAVR treatment. The results showed that those who underwent TAVR lived longer, with better symptom management, fewer hospital readmissions, and better functional status. At five years, 28.2% of the TAVR patients were still alive, compared to only 6.4% of those undergoing standard therapy. Echo cardiography at five years showed durable hemodynamic benefit after TAVR, with no evidence of structural valve deterioration. The study was published on March 15, 2015, in the Lancet.

“TAVR should be strongly considered for patients who are not surgical candidates for aortic valve replacement to improve their survival and functional status,” concluded lead author Prof. Samir Kapadia, MD, director of the cardiac catheterization laboratories at the Cleveland Clinic. “This trial is the first—and will probably be the only—randomized aortic stenosis trial that includes a group of patients not treated with aortic valve replacement, since these results will make it unethical to treat severe aortic stenosis patients with medical therapy alone.”

The percutaneous treatment of severe aortic valve disease (AVD) using a TAVR prosthetic aortic valve replacement, without the need for open heart surgery or cardiopulmonary bypass, is faster and less invasive than current open-heart procedures. TAVR has so far been proven effective in high-risk and inoperable patients, and could soon become the standard of care even in moderate and low surgical risk patients.

Related Links:
Cleveland Clinic
Emory University