Study Says Most Patients Can Now Benefit from TAVR Procedure

20 Jun Study Says Most Patients Can Now Benefit from TAVR Procedure

According to the Columbia Surgery blog, Transcatheter Aortic Valve Replacement (TAVR), is considered the new “gold-standard” for treating people suffering from aortic valve disease.

An estimated 300,000 Americans are diagnosed annually with severe aortic stenosis, a condition where the aortic valve doesn’t open fully, decreasing blood flow from the heart to the body. For those who are too high risk for traditional open heart surgery, TAVR is the way to go. Photo Credit: U.S. Department of Veteran Affairs

In the TAVR procedure, considered less-invasive for fixing stiff, damaged aortic valves (called aortic stenosis) than traditional valve surgery, doctors get to the aortic valve through by using very small incisions to pass a thin tube called a catheter through the blood stream.  The catheter can then be used as a guide to send a replacement valve up to the heart, where it can take over for the damaged, old valve.  Traditional valve surgery, involving the opening of the patient’s chest bone to give surgeons access to the heart.

While being communing used in hospital’s operating rooms for years, initially TAVR was considered to be a last-chance option for people with highly severe aortic disease who couldn’t endure the intensity of a traditional surgery. Gradually, data compile from early research changed how TAVR was used. The surgical procedure became an option for use on patients with slightly less surgical risk. As its medical use was expanded, research findings indicated it could be a safe alternative to traditional surgery.

TAVR is Safe Alternative to Traditional Surgery

The Columbia Surgery blog notes that over the years, TAVR has become one of the best-studied procedures in heart care, generating some of the highest-quality evidence to show that it works for high, medium and low-risk cases of aortic disease.

One of the latest research studies (e.g., the PARTNER 3 study) was published by the New England Journal of Medicine, notes the Columbia Surgery blog.  The research study, co-authored by cardiac surgeon Craig R. Smith, M.D., of Columbia University Irving Medical Center (CUIM), was released at the 2019 American College of Cardiology annual meeting in March.  The CUIM researchers investigated the outcome of 1,000 hospital patient’s in 71 facilities – half of these patients underwent traditional open-heart surgery and the other half TAVR for one year.

The study findings indicated that people in the TAVR group had significantly lower rates of death, stroke or re-hospitalization after one year (8.5 percent vs.15.1 percent for open-heart surgery), says the Columbia Surgery blog. The researchers found that 0 to 3 days after surgery, those who underwent a TAVR procedure had lower rates of death or stroke and new-onset atrial fibrillation compared to open-heart surgery.

Passing the Baton

“Defying many predictions, the results of the PARTNER 3 Trial convincingly show that the baton has been passed from surgical aortic valve replacement (SAVR) to transcatheter aortic valve replacement (TAVR) for the treatment of most patients with aortic valve stenosis.  Patients like those who were enrolled in the trial (older, three-leaflet valves, calcific stenosis) represent the majority of patients with aortic stenosis, for whom TAVR is now the procedure of first choice,” says Dr. Smith explaining the research findings.

“The trial also demonstrates that the displaced gold standard (surgery) also has outstanding results, which is good news for those patients whose aortic valve disease is not yet ideally suited for TAVR, says Dr. Smith, advising referring patients to keep this in mind when dealing with patients in which TAVR is still not the best choice, specifically those with multivalve issues, complex coronary artery disease, bicuspid valve disease and other complex problems.

“The results presented [in PARTNER 3] should not be used to make patients in those categories feel disadvantaged because they ‘must have’ surgery,” says Smith.

The researchers say there are limitations to the study their analysis takes a look at 30 days and one year after surgery, which does not address the problem of long-term heart valve deterioration. Future studies will need to address long-term outcomes, added the investigators, noting that the results of this study are “the first of its kind.”