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Similar mortality, but more vascular events, with transcatheter valve replacement

NEW YORK (Reuters Health) – Moderate-to-high-risk patients with aortic stenosis have similar mortality rates with transcatheter or surgical aortic valve replacement, a recent study shows.

Patients did seem to have more vascular complications with the less invasive procedure, however. A third of patients with transcatheter aortic valve replacement (TAVR) had vascular complications, versus 0.9% of the patients who had surgical aortic valve replacement (SAVR).

But about a quarter of the SAVR patients developed acute kidney injury, compared to 8% of TAVR patients.

The risk of vascular complications with TAVR appears to be declining with the introduction of smaller catheter systems, Dr. Antonio Colombo of the EMO-GVM Centro Cuore Columbus in Milan and his colleagues note in their report of the study, published online October 31 in the American Heart Journal.

Still, they said, “The higher rate of major vascular complications associated with transcatheter therapy….needs to be addressed before this less invasive approach can become the standard of care.”

In high-risk patients capable of undergoing surgery, a 2011 study found one-year all-cause mortality with TAVR was “non-inferior” to SAVR, Dr. Colombo and his team note.

The goal of their new study was to compare “real-world” outcomes of the two procedures in moderate-to-high-risk patients.

They matched 111 patients treated with transfemoral TAVR with 111 historical case controls treated with SAVR, using propensity scores that accounted for clinical characteristics and surgical risk.

At 30 days, 1.8% of patients in both groups had died from any cause. At one year, the all-cause mortality rates were similar, at 6.4% for the TAVR patients and 8.1% for the SAVR patients. The one-year risk of cerebrovascular complications was also similar for the TAVR and SAVR groups, at 4.6% and 9.1%, respectively.

Both procedures were highly effective, with 90% of SAVR patients and 95% of TAVR patients ranked New York Heart Association class II or below at one year after the procedure.

“These procedures are associated with different periprocedural risks, which need to be discussed with patients when recommending either approach,” the researchers write. “The excellent survival rates after transfemoral TAVR in an elderly population with intermediate STS scores justifies current efforts such as the SURTAVI trial to compare transcatheter and surgical valve replacement in moderate-risk patients.”

SOURCE: http://bit.ly/RIc0BL

Am Heart J 2012.