TAVR a Viable Option for Intermediate-Risk Patients

Among aortic stenosis patients at intermediate surgical risk, transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) yield similar longer-term mortality rates after adjustment for baseline risk and comorbidities, according to results presented at TCT.

Gerhard Schymik, MD, of the Municipal Hospital Karlsruhe, Karlsruhe, Germany, and colleagues identified 1,141patients from the TAVI Karlsruhe Registry with a logistic EuroSCORE of 15 or less who underwent TAVR (n = 419) or SAVR (n = 722) between 2007 and 2012.

Mortality similar

The mean logistic EuroSCORE was 10.1±2.8 in the TAVR group and 5.7±.2 in the SAVR group (P<.0001). Over three years, the likelihood of survival was higher for surgery patients (log-rank test P=.0023).

In a separate anlaysis, the researchers used propensity scoring to match 432 patients. The mean logistic EuroSCOREs of TAVR patients and SAVR patients were comparable (8.7±2.7 vs. 8.8 ±2.8; P=.52).

Survival probability over 3 years was similar between the treatment groups (log-rank test P=.2196). However, TAVR patients had higher rates of major vascular complications, new pacemaker implantation, and moderate aortic insufficiency, whereas SAVR patients had more major and life-threatening bleeding complications (Table 1).

Table 1. Complications in Propensity-Matched Patients

New data support TAVR for lower-risk patients

In the past few years, growing experience and continued improvement in clinical outcomes with TAVR have stimulated interest in the less invasive procedure for patients at intermediate surgical risk, Schymik told TCT Daily. However, data have been limited by small sample sizes, limited follow-up, and inadequate consideration of differences in patient and disease characteristics.

According to Schymik, the current results add to previous research by looking at a larger patient group, many with substantially lower baseline risk, and by following patients for a longer period.

“We demonstrated that off-pump treatment of severe aortic stenosis with transcatheter valves in patients with intermediate risk for surgical mortality may be an equally appealing procedure for selected elderly patients with less [overall] comorbidity but in whom [certain] comorbid conditions may not be considered by current risk scoring tools,” Schymik said.