TAVR Improving Heart Valve Outcomes

Transcatheter aortic valve replacement availability for aortic stenosis patients associated with lower death rate

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) A new method for treating a heart common valve condition was introduced in the US in 2012. Now new research is exploring its effects.

The researchers behind a new study examined different options for treating aortic stenosis, including surgical aortic valve replacement and the newer transcatheter aortic valve replacement.

This study found that as the second option was introduced, rates of both procedures increased, and death rates related to the procedures saw a drop.

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In cases of aortic stenosis, the aortic valve in the heart stiffens and narrows, restricting blood flow to the rest of the body and overworking the heart muscle. The American Heart Association (AHA) reported that aortic stenosis is one of the most common and most serious forms of heart valve problems.

According to this study's authors, who were led by J. Matthew Brennan, MD, MPH, of the Duke University Medical Center in Durham, North Carolina, an increase in aortic valve replacement procedures has been seen along with better outcomes from these surgeries thanks to a new procedure.

The new procedure — transcatheter aortic valve replacement (TAVR) — became commercially available in 2012.

"This minimally invasive surgical procedure repairs the valve without removing the old, damaged valve," explained AHA. "Instead, it wedges a replacement valve into the aortic valve’s place."

In the traditional replacement procedure — surgical aortic valve replacement (SAVR) — the damaged valve needs to be removed completely.

To examine these aortic valve replacements in recent years, Dr. Brennan and team utilized the STS Adult Cardiac Surgery Database to track both SAVR and TAVR cases from 2008 to 2012. Data from the 2012 STS/ACC Transcatheter Valve Therapy Registry was also used.

During the time examined, the annual volume of aortic valve procedures increased from an average of 34,699 to 43,282 cases.

According to the study's authors, this increase was due to SAVR being used in more low- and medium-risk cases, and TAVR being used in more high-risk cases. The researchers noted that the number of high-risk SAVR cases saw a slight dip in 2012, when TAVR became available.

But the use of either procedure for high-risk cases increased from 4,249 cases in 2011 to 8,082 cases in 2012 — nearly a doubling of procedures.

During the same time, deaths in hospitals from either procedure in high-risk cases dropped from 8.9 percent of cases in 2011 to 7.0 percent of cases in 2012.

In a news release, Dr. Brennan said that having multiple options available for surgery means better results for patients.

“In the initial US experience, early outcomes following aortic valve replacement have improved with the availability of TAVR technology,” explained Dr. Brennan.

“When surgeons have multiple treatment options, more patients will benefit. We expect this trend to continue as both device technology and patient selection continue to evolve,” he continued.

This study was presented January 28 at the 50th Annual Meeting of The Society of Thoracic Surgeons. It is important to note that studies presented at conferences are considered preliminary until published in a peer-reviewed journal.

Several study authors reported commercial relationships with a variety of organizations, including Janssen Pharmaceutical, Edwards Lifesciences Corporation and Eli Lilly.

Review Date: 
January 27, 2014
Last Updated:
January 29, 2014