Original Title: Utilization and 1-Year Mortality for Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement in New York Patients With Aortic Stenosis2011 to 2012. Reference:Hannan EL et al. J Am CollCardiolIntv. 2016;9(6):578-585.
Courtesy of Dr. Agustín Vecchia
It’s been only 14 years sinceCribierperformed the first transcatheter valve replacement. Today, during 2016, 100,000 patients are expected to undergo the procedure worldwide.
This observational retrospective study of all patients undergoing surgical valve replacement (SAVR) and transcatheter aortic valve replacement(TAVR) in New York between the years 2011 and 2012. The study evaluate mortality at one year for both procedures and the trends in use, according to the risk profile of each patient.
Patients undergoing TAVR and SAVR were propensity score matched using multiple risk factors and were stratified according to risk profile.
The total number of patients undergoing TAVR increased from 2291 cases in 2011 to 2899 in 2012 (27%). SAVR rate increased 7.1% (1994 to2135) and TAVR rate increased 157% (from 297 to 764 cases). The percentage of surgeries in high risk patients (>3% New York State [NYS] score, or equivalent to8%STS) decreased from 27 to 23% and TAVR percentage in high risk patients decreased from 83 to 76%. There were no differences in mortality at one year between TAVRand SAVR (15.6% vs. 13.1%; HR: 1.30 CI 95%: 0.89 to 1.92). There were no differences between NYS <3% patients (12.5% vs. 10.2%; HR: 1.42 CI 95%: 0.68 to 2.97) or between patients with >3% scores (12.5% vs. 10.2%; HR: 1.42 CI 95%: 0.68 to 2.97).
The authors concluded that the presented registry shows TAVR has expanded to a wider group of patients. Despite this, there were no differences in mortality between the two procedures.
Editorial Comment
Even though randomized studies are the gold standard to evaluate therapeutic options, well conducted registries such as the one being presented, are more generalized and allow us to assess the use of these procedures.
Two main conclusions can be obtained from the present publication. On one hand, TAVR is behind the increased number of treated patients; this technique is being increasingly used with high and intermediate risk patients. On the other hand, one year follow up outcomes resulted similar in both groups, which may validate the advantage of the adequate selection system in the participating centers, were both treatments were available.
The following registry only assessoutcomes at short term (12 months) but confirms the trend and gives us an idea of the magnitude of this ever increasing trend that has been taking place in the last years as regards the use of TAVR, its increasing use in intermediate risk patients and its similar performance to SAVR.
Courtesy of Dr Agustín Vecchia.
