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Apr 05, 2011

Treatment Options for Patients with Severe Aortic Stenosis

Minimally-invasive procedure, TAVI, is promising for patients with severe aortic stenosis.

A recent study, known as the PARTNER trial, investigated the use of transcatheter aortic valve implantation (TAVI) as a safer alternative to surgical aortic valve replacement in high risk patients with aortic stenosis. In patients with aortic stenosis, the aortic valve, which allows blood to flow away from the heart, does not open fully, decreasing blood flow from the heart. Fortunately, patients with mild aortic stenosis do not require treatment, though they should be observed by a cardiologist until symptoms develop. However, aortic stenosis can progress over time, worsening symptoms and increasing the severity of the condition, which can ultimately lead to heart failure.

Treatment for patients with symptoms for aortic stenosis is crucial to improving their prognosis, but the most common procedures, such as valve replacement surgery, can be risky. For those with severe aortic stenosis, their fragile health can put them at such high risk that they are considered inoperable.  As a result, the PARTNER trial investigated the use of TAVI, which is a significantly less-invasive procedure than surgical aortic valve replacement, in high risk patients.

Principal findings show that among nearly 700 patients, mortality in high risk patients undergoing TAVI was significantly decreased in comparison with those undergoing aortic valve replacements at both 30 days and one year. Data also revealed transfemoral TAVI to be more effective than transapical TAVI. However, rates for vascular complications and strokes were higher with TAVI than valve replacement.

Initial findings from the PARTNERS trial are encouraging. With additional research, TAVI could provide a safer alternative for patients with severe aortic stenosis, for whom surgical aortic valve replacement would be extremely risky. Also, through indications that transfermoral TAVI may be significantly safer than transapical, these results will help drive further research to compare these procedures and ultimately help improve outcomes for all patients suffering from aortic stenosis.

Questions for You to Consider

  • What types of patients were included in the PARTNERS trial?

  • In a separate PARTNER trial cohort, data showed that TAVI was superior to surgical aortic valve replacement in inoperable patients. The PARTNER trial mentioned above instead investigated the comparison of these two procedures on high risk patients with severe aortic stenosis that were eligible for surgery.
  • How can doctors determine the severity of aortic stenosis in patients?

  • Aortic stenosis is considered mild in patients that do not exhibit symptoms, such as chest pain, fainting and shortness of breath. However, aortic stenosis worsens over time as the area of aortic valve decreases, lessening the amount of blood flowing from the heart. Severity of arotic stenosis can be determined by symptoms and the size of the aortic valve area. Those with aortic stenosis should be continually monitored by a cardiologist to track the progression of this condition, and strenuous activity should be avoided in those with moderate to severe aortic stenosis.


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