Temporal Trends in Transcatheter Aortic Valve Replacement for Isolated Severe Aortic Stenosis

A study by the Northern New England Cardiovascular Disease Group Consortium recently published online identified all patients with aortic valve stenosis treated with surgical or transcatheter aortic valve replacement between 2016 and 2022 in Maine, New Hampshire, and Vermont (USA).

Tendencias temporales en el reemplazo valvular aórtico transcatéter para la estenosis aórtica grave aislada

These patients were divided for analysis into three age groups: under 65 years old, 65 to 80 years old, and over 80 years old. A multivariate logistic regression analysis was conducted on the <65 years group to identify predictors of transcatheter aortic valve implantation (TAVI), with variables such as age, sex, body mass index, left ventricular ejection fraction, urgent or elective surgery, functional class, bicuspid aortic valve anatomy, and relevant comorbidities.

Of the 6728 patients assisted during the aforementioned period (40.2% women), 1634 underwent surgery and 5094 underwent percutaneous intervention. 

The incidence of percutaneous implantation progressively increased from 2016 to 2022 in all three age groups, reaching 51.7% of all patients <65 years old in 2022, 85.8% in the 65 to 80 years old group, and 97.8% of all patients over 80 years old. In this last group, only 2.2% of patients underwent surgical valve replacement.

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In the group of patients <65 years old, among whom—despite the recommendations in the 2020 guidelines—TAVI increased by 272%, researchers found as independent predictors of TAVI the presence of previous revascularization surgery and congestive heart Failure, while the presence of bicuspid aortic valve disease was the most powerful independent predictor of surgical aortic valve replacement. Interestingly, the increase in TAVI in patients <65 years old was driven by an increase in low-risk patients who underwent this procedure.

The authors of this study clarify that these results may not necessarily reflect practice nationwide. However, the fact that TAVI could currently be used in more than 60% of adults over 60 years old with isolated aortic valve stenosis has implications for management strategies throughout the lives of these patients.

Note: The Northern New England Cardiovascular Disease Group Consortium is a collaborative regional group of four cardiovascular programs in Northern New England (Maine, New Hampshire, and Vermont)

Dr. José Álvarez
Director of the Website and the Editorial Board of SOLACI.org.

Original Title: Temporal Trends in Transcatheter Aortic Valve Replacement for Isolated Severe Aortic Stenosis.

Reference: Tanush Gupla MD, James T. DeVries MD, Fahad Gilani MD, Ansar Hassan MD, Cathy S. Ross MS, Harold L. Dauerman MD. Journal of the Society for Cardiovascular Angiography and Interventions. Publicado on-line el 05 de abril de 2024.  

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