Game Changer: TAVR May Be Safer Than Surgery

PARTNERS -3 and Evolute trials may change they way we treat aortic stenosis

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Photo by JAFAR AHMED on Unsplash

It is a potential game-changer.

Two studies were released during the annual meeting of the American College of Cardiology today. They are the PARTNER-3 and Evolut trials, comparing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR).

The aortic valve is the valve between the heart and main artery pumping blood to the rest of the body, the aorta. In many patients, this valve becomes extremely narrowed, or have stenosis, and this puts pressure on the heart causing it to fail. The condition is called aortic stenosis.

Traditionally, this could only be fixed with open heart surgery, where the chest would be cut open and the ribs split. Obviously, this type of surgery was associated with a lot of complications, including stroke and even death. More recently, a less invasive way of replacing the valve was developed: TAVR.

Up until this point, this less invasive way to replace the valve was usually reserved for the sickest patients, who would not tolerate open heart surgery. The question became, would this procedure be as good as surgery for those patients with lower surgical risk? It appears that the two studies above have answered this question in a resounding affirmative.

Here are the findings of the PARTNERS-3 study:

The results of the Evolut study are below:

Like I said above, this is a potential game changer. Here is what the ACC said on its website:

Many patients can go home after one or two days with this less invasive aortic valve replacement surgery option, as opposed to several days in the hospital after open heart surgery. And as the studies show, this procedure may even be safer than surgery. This is pretty huge.

Now, the transcatheter approach is not without its own complications: both studies showed an increase in valve leakage, and one study showed more patients needed permanent pacemakers. Furthermore, the jury is still out on whether these initial good outcomes are sustainable over the long term.

That said, if this procedure gets approved by the FDA for those patients with aortic valve disease that are healthier, this may change the whole standard of care of treating aortic stenosis, with many implications on both patients and hospitals. Quite exciting, and we will see what the future holds.

The opinions expressed in this post are my own and do not reflect those of my employer or the organizations with which I am affiliated.

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NY Times featured Pulmonary and Critical Care Specialist | Physician Leader | Author and Blogger | His latest book is “Code Blue,” a medical thriller.

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