This year’s TCT conference saw a deluge of TAVR studies examining everything from the efficacy of valve designs to TAVR’s impact on aortic and tricuspid regurgitation.
Out of all these TAVR studies, the four that could have the greatest clinical impact focused on interventional timing and the risk of comorbidities and procedural complications.
The EARLY TAVR trial shined the brightest spotlight on TAVR timing, finding that earlier intervention in patients with asymptomatic severe AS may be more beneficial than watchful waiting.
- Patients who received early TAVR were 16% less likely to experience MACE and saw better heart function over a median of 3.8 years, which may be enough to challenge current guidelines that call for routine surveillance every 6 to 12 months.
Conversely, the similarly structured EVOLVED trial found that early TAVR failed to lower mortality risks in asymptomatic AS patients who had evidence of myocardial fibrosis (14% vs. 13% for conservative care).
- However, early TAVR could increase these patients’ healthspan thanks to better symptom control and fewer hospitalizations (6% vs. 17%).
The TAVR UNLOAD trial also found that there’s not much to gain by performing earlier TAVR in patients with HFrEF and moderate aortic stenosis.
- Earlier TAVR didn’t result in statistically better outcomes than clinical surveillance, but it did support a greater improvement in overall KCCQ scores (12.8 vs 3.2).
The PROTECTED TAVR trial rounded out the major TAVR late-breakers, finding that cerebral embolic protection’s benefits varied geographically, and somehow didn’t reduce overall strokes.
- The study revealed significant stroke risk reductions with U.S.-performed TAVRs (-50% overall, -73% disabling), but no stroke benefits when performed outside the U.S.
The Takeaway
In addition to highlighting the massive role that TAVR plays in interventional cardiology workloads, the major TCT2024 TAVR trials’ mixed results related to procedure timing and patient complications underscored just how important an individualized approach is for TAVR.
