Interventional cardiology

ACC 2022: Valve deterioration worse when surgically-inserted

The incidence of structural valve deterioration (SVD) is significantly lower in patients who received transcatheter aortic valve replacement (TAVR) than in those who received surgical aortic valve replacement (SAVR).

As well, SVD leads to worse clinical outcomes, the American College of Cardiology’s 71st Annual Scientific Session was told.

The US study, which analysed data from 1,128 TAVR and 971 SAVR patients from two large, randomised trials found SVD rates were 2.6% and 4.4% at five years respectively.

It found the difference in SVD was more profound in patients with smaller (≤23 mm) annuli (1.39% with TAVR v 5.86% with SAVR).

Senior investigator Professor Michael Reardon, from Houston Methodist, said patients with SVD were about twice as likely to die or need to be rehospitalised for valve-related disease or heart failure as those who did not develop SVD.

Multivariate analysis found independent predictors of valve deterioration were a higher body surface area while there was a lower risk of SVD in men, older patients and those with prior PCI and atrial fibrillation.

Professor Reardon said TAVR is FDA approved for use in patients of all ages and risk levels who need a replacement heart valve.

“However, heart surgeons tend to worry that in younger, lower-risk patients, replacement valves inserted using TAVR may fail more quickly than surgically inserted valves,” he said.

“The results of this study suggest exactly the opposite—that at five years, the TAVR-inserted valve has less structural deterioration than the surgically inserted one.”

“Using Doppler echocardiography alone, we have shown that SVD occurred statistically significantly more frequently with SAVR than with TAVR and was associated with a doubling of risk for mortality or rehospitalisation for valve failure,” Professor Reardon said.

While the current study was limited to five years of follow-up, longer term follow-up is ongoing.

“Patients in the two ongoing trials, SURTAVI for intermediate risk and Evolut for low risk, will each be followed for 10 years to help answer this question.”

The study was funded by Medtronic.

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