A new JACC study highlighted the long term benefits of TAVR using the Evolut valve (Medtronic) compared to surgical AVR when it comes to avoiding bioprosthetic valve dysfunction (BVD).
- Now over 20 years since the first TAVR, the method is an established alternative to surgery in patients with symptomatic severe AS, regardless of surgical risk.
- However, while both TAVR and SAVR have their benefits in certain populations, few studies compare long-term valve stability between the two.
Pitting data from the two techniques head-to-head, researchers examined 5.6k patients from the US High Risk Pivotal and SURTAVI randomized controlled trials, finding that TAVR patients experienced significantly lower rates of BVD over the study’s five year follow-up.
- Only 9.7% of patients undergoing TAVR with the Evolut valve experienced BVD, compared to 15.3% of surgical patients.
Even though prosthetic valves can be replaced, valve dysfunction is still important to keep top of mind considering the long-term survivability and quality-of-life impacts patients face following valve implantation.
- In the case of this study, patients who experienced BVD faced a 49% greater all-cause mortality risk, 76% greater CV mortality risk, and 48% higher hospitalization rates.
Although TAVR’s benefits are pretty clear, there’s a catch – the study’s patient population consisted of mostly older patients (mean age 82), which could skew results away from surgery and toward TAVR.
- The study’s data analysis also included 3,262 patients from non-randomized controlled trials, which is well over half (58%) of the study population.
- Without built-in control and randomization, this patient data could also cast doubt on the impressive benefits seen.
The Takeaway
While it’s not a definitive slam dunk, the results of this data analysis study do support the trend that older AS patients certainly benefit more from non-invasive TAVR over the riskier surgical approach.
