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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Transcatheter aortic-valve replacement for inoperable severe aortic stenosis
Raj R Makkar1, Gregory P Fontana, Hasan Jilaihawi
1Cedars-Sinai Heart Institute, Los Angeles, USA.
The New England Journal of Medicine
|March 27, 2012
Summary
Transcatheter aortic-valve replacement (TAVR) significantly reduced death and hospitalization rates in patients with severe aortic stenosis unsuitable for surgery. The survival benefit may be limited in patients with extensive coexisting conditions.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Transcatheter aortic-valve replacement (TAVR) is recommended for severe aortic stenosis patients ineligible for surgery.
- Long-term outcomes (beyond 1 year) of TAVR in this population were previously unknown.
Purpose of the Study:
- To evaluate the 2-year outcomes of transfemoral TAVR compared to standard therapy in patients with severe aortic stenosis unsuitable for surgery.
Main Methods:
- A randomized trial comparing transfemoral TAVR with standard therapy (including balloon aortic valvuloplasty) was conducted.
- Two-year outcomes were analyzed in 358 patients across 21 centers.
Main Results:
- TAVR significantly reduced 2-year mortality (43.3% vs. 68.0%) and cardiac death (31.0% vs. 62.4%) compared to standard therapy.
- Stroke rates were higher with TAVR (13.8% vs. 5.5%), with ischemic events early and hemorrhagic strokes later.
- Rehospitalization rates were substantially lower with TAVR (35.0% vs. 72.5%), alongside improved functional status and sustained valve hemodynamics.
Conclusions:
- TAVR demonstrated sustained benefits in reducing death and hospitalization, improving symptoms, and enhancing valve hemodynamics at 2 years for appropriately selected patients.
- The survival advantage of TAVR may be attenuated in patients with extensive coexisting conditions.
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