Transcatheter aortic valve implantation for aortic stenosis

January 01, 0001

Transcatheter aortic valve implantation for aortic stenosis

Many patients with severe aortic stenosis and coexisting conditions are not candidates for surgical replacement of the aortic valve. Recently, transcatheter aortic-valve implantation (TAVI) has been suggested as a less invasive treatment for high-risk patients with aortic stenosis. These investigators from the US, UK, and Canada randomly assigned patients with severe aortic stenosis, whom surgeons considered not to be suitable candidates for surgery, to standard therapy (including balloon aortic valvuloplasty) or transfemoral transcatheter implantation of a balloon-expandable bovine pericardial valve. The primary end point was the rate of death from any cause.

They found: "A total of 358 patients with aortic stenosis who were not considered to be suitable candidates for surgery underwent randomization at 21 centers (17 in the United States). At 1 year, the rate of death from any cause (Kaplan-Meier analysis) was 30.7% with TAVI, as compared with 50.7% with standard therapy. The rate of the composite end point of death from any cause or repeat hospitalization was 42.5% with TAVI as compared with 71.6% with standard therapy. Among survivors at 1 year, the rate of cardiac symptoms (New York Heart Association class III or IV) was lower among patients who had undergone TAVI than among those who had received standard therapy (25.2% vs. 58.0). At 30 days, TAVI, as compared with standard therapy, was associated with a higher incidence of major strokes (5.0% vs. 1.1%) and major vascular complications (16.2% vs. 1.1%). In the year after TAVI, there was no deterioration in the functioning of the bioprosthetic valve, as assessed by evidence of stenosis or regurgitation on an echocardiogram."

The authors concluded: "In patients with severe aortic stenosis who were not suitable candidates for surgery, TAVI, as compared with standard therapy, significantly reduced the rates of death from any cause, the composite end point of death from any cause or repeat hospitalization, and cardiac symptoms, despite the higher incidence of major strokes and major vascular events."

An option that may be considered in the corresponding population if the cost is within reason.


For the full abstract, click here.

N Engl J Med online 22 September 2010
© 2010 to the Massachusetts Medical Society
Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. Martin B. Leon, Craig R. Smith, Michael Mack, et al. Correspondence to Dr. Leon: [email protected]

Category: K. Circulatory. Keywords: aortic valve, stenosis, replacement, death, hospitalization, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 19 October 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.