TY - JOUR
T1 - Clinical practice update
T2 - Who should be referred for transcatheter aortic valve replacement in 2017?
AU - Barker, Colin M.
AU - Reardon, Michael J.
N1 - Publisher Copyright:
© Radcliffe Cardiology 2017.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2017
Y1 - 2017
N2 - Transcatheter aortic valve replacement (TAVR) was initially envisioned as a less invasive option for patients with severe symptomatic aortic stenosis (AS) either not candidates or very high-risk candidates for surgical aortic valve replacement (SAVR). Based on data from the original Placement of Aortic Transcatheter Valves (PARTNER) trial and CoreValve® US Pivotal trials, TAVR is now approved and accepted in the treatment for severe symptomatic AS in extreme-, high-, and intermediate-risk patients. Thus far, the randomized controlled trial data for TAVR have been non-inferior or even superior to both medical therapy and SAVR. Given all the data, the logical next step is to study low-risk patient groups. Anecdotal and non-randomized data have been conflicting when comparing TAVR with SAVR in low-risk patients. Two low-risk randomized trials have started in the US, and ultimately, these trials will determine the feasibility of TAVR as an acceptable alternative to SAVR in low-risk patients with severe AS. Thus, in 2017, any patient with AS should be referred to a multidisciplinary valve team to be evaluated for TAVR, SAVR, or nothing, depending on risk and availability of ongoing clinical trials.
AB - Transcatheter aortic valve replacement (TAVR) was initially envisioned as a less invasive option for patients with severe symptomatic aortic stenosis (AS) either not candidates or very high-risk candidates for surgical aortic valve replacement (SAVR). Based on data from the original Placement of Aortic Transcatheter Valves (PARTNER) trial and CoreValve® US Pivotal trials, TAVR is now approved and accepted in the treatment for severe symptomatic AS in extreme-, high-, and intermediate-risk patients. Thus far, the randomized controlled trial data for TAVR have been non-inferior or even superior to both medical therapy and SAVR. Given all the data, the logical next step is to study low-risk patient groups. Anecdotal and non-randomized data have been conflicting when comparing TAVR with SAVR in low-risk patients. Two low-risk randomized trials have started in the US, and ultimately, these trials will determine the feasibility of TAVR as an acceptable alternative to SAVR in low-risk patients with severe AS. Thus, in 2017, any patient with AS should be referred to a multidisciplinary valve team to be evaluated for TAVR, SAVR, or nothing, depending on risk and availability of ongoing clinical trials.
KW - Clinical trials
KW - Durability
KW - Heart team
KW - Risk
KW - TAVR
KW - Transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85034115168&partnerID=8YFLogxK
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U2 - 10.15420/usc.2017:22:1
DO - 10.15420/usc.2017:22:1
M3 - Article
AN - SCOPUS:85034115168
VL - 11
SP - 67
EP - 71
JO - US Cardiology Review
JF - US Cardiology Review
SN - 1758-3896
IS - 2
ER -