Surgical aortic valve replacement should remain the standard treatment for aortic stenosis

October 20, 2010, Boston University Medical Center

Despite the promising results of the "Placement of Aortic Transcatheter Valves (PARTNER) trial," featured in the Oct. 21 issue of the New England Journal of Medicine, a cardiothoracic surgeon from Boston Medical Center (BMC) believes that surgical aortic-valve replacement should remain the standard treatment of aortic stenosis. In the accompanying editorial, the author argues that Transcatheter aortic-valve implantation (TAVI) should be reserved for patients at inordinately high risk who are not suitable candidates for surgery and who have decreased life expectancy.

Aortic-valve replacement is the most effective treatment to alleviate symptoms and improve survival in patients with critical . However, a substantial number of these patients have coexisting conditions that preclude surgery. Since outcomes with medical management are poor, a less invasive and safer alternative to surgical is needed for this expanding group of patients.

TAVI has emerged as an alternative treatment for aortic stenosis in patients who are considered to have a high or prohibitive surgical risk. In this week's Journal, Martin B. Leon and his coauthors report the results of the PARTNER trial, a prospective, randomized, multicenter trial to determine the optimal method of treating patients with critical aortic stenosis who are considered not to be suitable candidates for surgery. Patients who underwent TAVI as compared with patients receiving medical management, had a significantly lower rate of death at one year, fewer hospital readmissions, and a reduction in cardiac symptoms. These improved outcomes were achieved, however, at the cost of a significant increase in the rate of major strokes and vascular events.

"Now that there is evidence-based clinical data to substantiate the benefits of TAVI in patients who are not suitable candidates for surgery, there will be a temptation to expand this technology to all patients with aortic stenosis," said editorial author Harold Lazar, MD, a professor of cardiothoracic surgery and Director of the Cardiothoracic Surgical Laboratories at the Boston University School of Medicine (BUSM).

According to Lazar a number of issues must be resolved prior to deciding what role TAVI may play in the treatment of aortic stenosis including criteria to determine who is not a candidate for surgical aortic-valve replacement, who should perform TAVI and where should it be performed. "Only when these issues are addressed can we determine where we go from here," he stressed.

"Given what we know, TAVI should not be performed in patients with long life expectancies. Prospective, adequately powered, randomized trials comparing TAVI with surgical aortic-valve replacement in both high-risk and low-risk patients will be necessary to further define the role of TAVI in the treatment of aortic stenosis," he added.

Explore further: Clinical trial establishes catheter-based aortic valve replacement as new standard of care

Related Stories

Clinical trial establishes catheter-based aortic valve replacement as new standard of care

September 23, 2010
One-year data from the PARTNER clinical trial, published today in the New England Journal of Medicine, demonstrate that transcatheter aortic-valve implantation, compared with standard therapy, resulted in significantly lower ...

The huge opportunities for transcatheter aortic valve implantation

August 31, 2009
"Today, transcatheter aortic valve implantation (TAVI) represents an effective therapeutic alternative to conventional aortic valve replacement for patients who are at high risk or with contraindications to surgery, and the ...

Heart valves implanted without open-heart surgery

January 7, 2009
An innovative approach for implanting a new aortic heart valve without open-heart surgery is being offered to patients at NewYork-Presbyterian Hospital/Columbia University Medical Center. Known as the PARTNER (Placement of ...

Major discovery in the treatment of aortic valve stenosis

April 18, 2008
A team of scientists from the Université de Montréal and the Montreal Heart Institute Research Centre, led by Dr. Jean-Claude Tardif, has completed an important study that show how a new type of medication can lead to an ...

New heart valve replacement technologies offer hope for high-risk patients

March 8, 2010
A significant number of people with heart disease will benefit from less invasive transcatheter heart valve replacements in future, finds a review of updated practices in CMAJ (Canadian Medical Association Journal).

Few complications one year after aortic valve implantation

September 21, 2009
Research presented at the 21st annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, sponsored by the Cardiovascular Research Foundation (CRF), demonstrated an "exceptionally low" rate of complications ...

Recommended for you

Infants born to obese mothers risk developing liver disease, obesity

November 16, 2018
Infant gut microbes altered by their mother's obesity can cause inflammation and other major changes within the baby, increasing the risk of obesity and non-alcoholic fatty liver disease later in life, according to researchers ...

New study shows NKT cell subsets play a large role in the advancement of NAFLD

November 16, 2018
Since 2015 it has been known that the gut microbiota could have a direct impact on nonalcoholic fatty liver disease (NAFLD), which affects up to 12% of adults and is a leading cause of chronic liver disease. In the November ...

Antibiotic prescribing influenced by team dynamics within hospitals

November 15, 2018
Antibiotic prescribing by doctors is influenced by team dynamics and cultures within hospitals.

Zika may hijack mother-fetus immunity route

November 14, 2018
To cross the placenta, Zika virus may hijack the route by which acquired immunity is transferred from mother to fetus, new research suggests.

New research aims to help improve uptake of hepatitis C testing

November 14, 2018
New research published in Scientific Reports shows persisting fears about HIV infection may impact testing uptake for the hepatitis C Virus (HCV).

Maternally acquired Zika immunity can increase dengue disease severity in mouse pups

November 14, 2018
To say that the immune system is complex is an understatement: an immune response protective in one context can turn deadly over time, as evidenced by numerous epidemiological studies on dengue infection, spanning multiple ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.