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Published on: March 26, 2018
Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis
Philippe Généreux1, Allan Schwartz1, J Bradley Oldemeyer1
1From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.).
Early transcatheter aortic-valve replacement (TAVR) significantly reduces the risk of death, stroke, or hospitalization for patients with severe aortic stenosis compared to routine surveillance. This early intervention strategy offers improved outcomes for asymptomatic patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Current guidelines recommend surveillance for asymptomatic severe aortic stenosis with preserved ejection fraction.
- Randomized trial data on early transcatheter aortic-valve replacement (TAVR) versus surveillance are lacking.
Purpose of the Study:
- To compare the efficacy of early TAVR versus clinical surveillance in patients with asymptomatic severe aortic stenosis.
Main Methods:
- A randomized trial involving 901 patients at 75 centers.
- Patients were assigned 1:1 to early transfemoral TAVR or clinical surveillance.
- The primary endpoint was a composite of death, stroke, or unplanned cardiovascular hospitalization.
Main Results:
- Early TAVR significantly reduced the primary endpoint (26.8% vs 45.3%; hazard ratio, 0.50; P<0.001).
- Death rates were similar (8.4% vs 9.2%), but TAVR showed lower rates of stroke and cardiovascular hospitalizations.
- Most surveillance patients (87.0%) eventually received aortic valve replacement.
Conclusions:
- Early TAVR is superior to clinical surveillance for asymptomatic severe aortic stenosis.
- This strategy reduces the composite endpoint of death, stroke, or cardiovascular hospitalization.
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