Expansion of TAVR into Low-Risk Patients and Who to Consider for SAVR
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REVIEW
Expansion of TAVR into Low-Risk Patients and Who to Consider for SAVR Kunal V. Patel . Wally Omar . Pedro Engel Gonzalez . Michael E. Jessen . Lynn Huffman . Dharam J. Kumbhani . Anthony A. Bavry
Received: June 23, 2020 Ó The Author(s) 2020
ABSTRACT Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis (AS) over the last decade. The results of the Placement of Aortic Transcatheter Valves (PARTNER) 3 and Evolut Low Risk trials demonstrated the safety and efficacy of TAVR in low-surgical-risk patients and led to the approval of TAVR for use across the risk spectrum. Heart teams around the world will now be faced with evaluating a deluge of younger, healthier patients with severe AS. Prior to the PARTNER 3 and Evolut Low Risk studies, this heterogenous patient population would have undergone surgical aortic valve replacement (SAVR). It is unlikely that TAVR will completely supplant SAVR for the treatment of severe AS in patients with a low surgical risk, as SAVR has excellent short- and long-term outcomes and years of durability data. In this review, we Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12770000. K. V. Patel W. Omar P. E. Gonzalez D. J. Kumbhani A. A. Bavry (&) Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA e-mail: [email protected] M. E. Jessen L. Huffman Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, USA
outline the critical role that SAVR will continue to play in the treatment of severe AS in the postPARTNER 3/Evolut Low Risk era.
Keywords: Aortic stenosis; Low risk; SAVR; TAVR Key Summary Points The PARTNER 3 and Evolut Low Risk trials will greatly expand the use of TAVR to a significantly larger group of eligible patients with severe aortic stenosis. SAVR remains a vital treatment choice in patients with high anatomical risk including bicuspid aortic valve, heavy annular calcification, and low coronary heights. The long-term impact of increased pacemaker use, paravalvular regurgitation, and durability concerns associated with transcatheter heart valves is still unknown. Leaflet thickening and future coronary reaccess remain significant concerns with TAVR.
Cardiol Ther
INTRODUCTION In the last decade, the development of transcatheter aortic valve replacement (TAVR) has dramatically changed the management of symptomatic severe aortic stenosis (AS). Early studies showed a clear benefit with TAVR in prohibitive and high-surgical-risk patients (Society of Thoracic Surgery-Predicted Risk of Mortality [STS-PROM] [ 8%) [1, 2]. With ongoing refinement of TAVR technology, more accurate methods of annular sizing, and improvements in procedural technique, TAVR use has expanded to AS patients at intermediate surgical risk (STS-PROM 4–8%) [3, 4]. An analysis of surgical aortic valve replacements (SAVR) between 2002 and 2010 found that 80% of SAVRs are being performed in patien
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