TAVR treatment of severe aortic stenosis is becoming more and more common, showing comparable evolution, or even superior in some studies when using the femoral approach, vs. surgical aortic valve replacement (SAVR).
One of the current challenges is TAVR durability vs. SAVR. Even though 9 or 10 years has been deemed acceptable by current standards, we should not overlook the fact that there is a group of patients that will require reintervention, a scenario that we have not yet looked at in depth, let alone compared against surgery, which most likely will eventually be addressed.
This was a retrospective analysis of the CoreValve US Pivotal Extreme-Risk, High-Risk and SURTAVI trials, including 7,757 patients: 5,925 undergoing TAVR (4,478 CoreValve and 1,447 Evolute R/PRO) and 1,832 SVAR.
99 of these patients (1.3%) required reintervention; 80 were treated with TAVR (69 CoreValve and 11 Evolut R/PRO).
Read also: 12-Month Evolution of Edge-to-Edge Repair with PASCAL.
At 5 year followup, 99 patients (1.3%) needed reinterventions, most frequently TAVR patients (2.2% vs. 1.5%; P=0.017) vs SVAR. Reinterventions were more common during the first year (<1 year; adjusted subdistribution HR: 3.50; CI 95%: 1.53-8.02), but there were no differences between years 1 and 5 (adjusted subdistribution HR: 1.05; CI 95%: 0.48-2.28). The main cause behind reintervention in TAVR patients were regurgitations and in SAVR patients, endocarditis.
At 5 years, Evolut R/PRO presented a lower reintervention rate vs. CoreValve (0.9% vs. 1.6%; P=0.006), but there were no differences with SVAR (0.9% vs. 1.5%; P=0.41).
Conclusion
There was a lower reintervention rate for CoreValve/Evolut R/PRO and SVAR. Reinterventions were more frequent within the first year in TAVR patients and after the first year in SAVR patients. There were more reinterventions with first generation TAVR, CoreValve, and they were solved percutaneously. Reinterventions were more frequent with CoreValve than Evolut or SVAR.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Reinterventions After CoreValve/Evolut Transcatheter or Surgical Aortic Valve Replacement for Treatment of Severe Aortic Stenosis.
Reference: Kendra J. Grubb, et al. J Am Coll Cardiol Intv 2024;17:1007–1016.
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