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TAVI in Low-surgical Risk Patients

What is TAVI?

TAVI, which stands for Transcatheter Aortic Valve Implantation, is a minimally invasive surgical procedure used to replace damaged or narrowed aortic valves in the heart with new valves. The new valve is placed within the diseased valve and is sometimes called Transcatheter Aortic Valve Replacement .

This procedure is primarily used as a treatment method for severe aortic stenosis (AS). What happens here is the aortic valve becomes extremely narrow, hindering the blood flowing through it to the rest of the body. It can cause chest pain, fatigue, shortness of breath etc., and can lead to heart failure or sudden cardiac death.

TAVI Procedure

The procedure of TAVI is straightforward and is quite similar to placing a stent. There are two methods used to access the aortic valve. Using imaging techniques, a catheter may be passed up the femoral artery in the leg (transfemoral approach), or a small incision in the chest can be used to access large vessels in the chest or the left ventricle of the heart (transapical approach).  Once the catheter with the new valve reaches the narrowed aortic valve, a balloon on the catheter’s tip is inflated, and the new valve is appropriately positioned, relieving the narrowing1.

SAVR?

The other alternative to TAVI is open surgery involving a sternotomy, opening up the chest cavity and operating directly on the heart. This is called Surgical Aortic Valve Replacement (SAVR). Up until recently, TAVI was a procedure that was reserved to be used only on patients who fell into the intermediate or high-risk category to undergo surgery. In patients who were at low risk for complications following surgery, the preferred treatment was SAVR.

TAVI vs SAVR – Which is Better?

However, two recent studies, the PARTNER 3 trial and The Evolut Low-Risk trial have shown that even in low-risk patients, TAVI is a preferable option over SAVR. These studies conducted large clinical randomized trials where patients with severe aortic stenosis and low risk for surgery underwent either TAVI or SAVR. Overall, both studies agreed that TAVI was superior to SAVR for clinical outcomes, and there was a remarkable similarity between these two independently carried out studies.

A quick summary of the two studies; the PARTNER 3 trial was conducted over 12 months. It showed that TAVR had a reduced risk of death, stroke, and rehospitalization compared with SAVR (8.5% vs 15.1%) and had shorter days of hospitalization after surgery (3days vs 7 days). TAVR patients also had more rapid improvements in NYHA class of heart failure, 6-minute walk test distance and higher scores in the Kansas City cardiomyopathy Quality of life questionnaire. Life-threatening bleeds were also less with TAVI.

The Evolut low-risk trial was carried out over 24 months, and it showed that death or disabling stroke and rehospitalization even after 2 years was less in TAVI. At 30 days, there was less incidence of stroke, bleeding, acute kidney injury and atrial fibrillation as well.

TAVI is superior

As seen by the results of these studies, even in low risk for surgery patients for whom thus far the preferred treatment for severe aortic stenosis was SAVR, there is significant proof to show that TAVI is a superior treatment modality. SAVR does have excellent outcomes in the low-risk group. Still, TAVI has fewer deaths, strokes, and rehospitalization, not to mention that SAVR is a major surgery with higher costs than the relatively quick and less complicated TAVI.

If you think you may have aortic stenosis and are a suitable candidate to undergo TAVI as a low-risk category patient, do not hesitate to contact Dr Ankur Phatarpekar. He is an experienced heart specialist in Mumbai who is also regarded as one of the best heart surgeons. If you are from around Mumbai, feel free to visit or check our site to obtain more information about your condition and to decide on the best and most effective treatment for you.

References

  • American Heart Association. What is TAVR? (TAVI).
  • Tang GHL, Verma S, Bhatt DL. Transcatheter Aortic Valve Replacement in Low-Risk Patients. Circulation. 2019;140(10). doi:10.1161/CIRCULATIONAHA.119.041111
  • Hughes S. PARTNER 3: TAVR Success in Low-Risk Patients. Medscape Medical News.
  • Hughes S. TAVR With Evolut: Interim Results Promising in Low-Risk Patients. Medscape Medical News.

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