Title: All over for valve surgery for intermediate-risk patients?
Abstract: Based on the findings of three randomised trials 1 MacK MJ Leon MB Smith CR et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet. 2015; 385: 2477-2484 Summary Full Text Full Text PDF PubMed Scopus (1187) Google Scholar , 2 Kapadia SR Leon MB Makkar RR et al. 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet. 2015; 385: 2485-2491 Summary Full Text Full Text PDF PubMed Scopus (621) Google Scholar , 3 Adams DH Popma JJ Reardon MJ et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014; 370: 1790-1798 Crossref PubMed Scopus (2038) Google Scholar transcatheter aortic valve replacement (TAVR) is now first-line therapy in patients with severe aortic stenosis who are at high risk or are unsuitable for surgery. 4 Vahanian A et al. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS)Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012; 33: 2451-2496 Crossref PubMed Scopus (3200) Google Scholar , 5 Nishimura RA Otto CM Bonow RO et al. AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63: e57-185 Summary Full Text Full Text PDF PubMed Scopus (2094) Google Scholar As a consequence of rapid refinements of devices and procedure techniques there is a trend to extend TAVR to lower-risk patients. This trend has been encouraged by small propensity-matched studies and a small randomised trial in intermediate-risk and lower-risk patients, which showed favourable results compared with surgery. 6 Piazza N Kalesan B van Mieghem N et al. A 3-center comparison of 1-year mortality outcomes between transcatheter aortic valve implantation and surgical aortic valve replacement on the basis of propensity score matching among intermediate-risk surgical patients. JACC Cardiovasc Interv. 2013; 6: 443-451 Summary Full Text Full Text PDF PubMed Scopus (194) Google Scholar , 7 Latib A Maisano F Bertoldi L et al. Transcatheter vs surgical aortic valve replacement in intermediate-surgical-risk patients with aortic stenosis: a propensity score-matched case-control study. Am Heart J. 2012; 164: 910-917 Summary Full Text Full Text PDF PubMed Scopus (105) Google Scholar , 8 Tamburino C Barbanti M D'Errigo P et al. 1-year outcomes after transfemoral transcatheter or surgical aortic valve replacement:results from the Italian OBSERVANT study. J Am Coll Cardiol. 2015; 66: 804-812 Summary Full Text Full Text PDF PubMed Scopus (152) Google Scholar , 9 Thyregod HG Steinbrüchel DA Ihlemann N et al. Transcatheter versus surgical aortic valve replacement inpatients with severe aortic valve stenosis: 1-year results from the all-comers NOTION randomized clinical trial. J Am Coll Cardiol. 2015; 65: 2184-2194 Summary Full Text Full Text PDF PubMed Scopus (681) Google Scholar However, aside from the small number of patients, these studies had methodological weaknesses. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysisTAVR with SAPIEN 3 in intermediate-risk patients with severe aortic stenosis is associated with low mortality, strokes, and regurgitation at 1 year. The propensity score analysis indicates a significant superiority for our composite outcome with TAVR compared with surgery, suggesting that TAVR might be the preferred treatment alternative in intermediate-risk patients. Full-Text PDF
Publication Year: 2016
Publication Date: 2016-04-03
Language: en
Type: letter
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 8
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