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TAVR Offers Safe Alternative to Surgery for Many Patients with Aortic Stenosis

CardioSmart News

A new, minimally invasive procedure used to treat aortic stenosis may offer a safe option for patients that are too high-risk for surgery, according to research published in the New England Journal of Medicine.

Known as the PARTNER (Placement of Aortic Transcatheter Valves) 2 trial, this study compared the safety of two treatments for severe aortic stenosis—transcatheter vs. surgical aortic valve placement.

Transcatheter aortic valve replacement, often referred to as TAVR, is a new, minimally invasive procedure used to repair faulty aortic valves in patients with aortic stenosis. Surgical valve replacement, on the other hand, is a more invasive surgery that has been used for decades to treat this condition. Although surgery is the gold-standard for treatment, it can be too risky for certain patients like those with other serious health conditions. So while it’s a relatively new procedure, TAVR may be a safer, less-invasive option for higher risk patients.

To explore further, researchers randomly assigned more than 2,000 patients with severe aortic stenosis to TAVR or surgical replacement. Patients were considered “intermediate” risk for surgery, with overall risk scores from 4–8%. Participants were then followed for two years, tracking complications such as stroke and death.

After analysis, researchers found that TAVR was, at the very least, just as safe as surgery in higher-risk patients. After two years, risk of stroke or death was 19.3% in the TAVR group, compared with 21.1% in the surgical group. TAVR had even lower risk of complications when the valve was accessed through arteries in the leg rather than the chest.

Authors also note that patients undergoing TAVR had significantly lower rates of hospitalization, bleeding, kidney injury, and an abnormal heart rhythm called atrial fibrillation.  

Based on findings, authors conclude that TAVR is, at the very least, equally as safe as surgery for intermediate-risk patients with aortic stenosis. In fact, data suggests that TAVR may actually have lower risk of complications and faster recovery than traditional surgery.

However, it’s important to note that while the study included patients with “intermediate” risk for surgery, this level of risk is still fairly high. Past trials already suggest that TAVR is safe and effective in the highest-risk patients that are ineligible for surgery. This trial extended findings to confirm safety in intermediate risk patients. So while promising, findings only apply to patients with severe aortic stenosis that are considered higher risk for surgery.

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