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. 2012:6:125-39.
doi: 10.4137/CMC.S7540. Epub 2012 Aug 23.

TAVR and SAVR: Current Treatment of Aortic Stenosis

Patrick P Hu  1
Affiliations

TAVR and SAVR: Current Treatment of Aortic Stenosis

Patrick P Hu. Clin Med Insights Cardiol. 2012.

Abstract

Transcatheter aortic valve replacement (TAVR) was approved in the United States in late 2011, providing a critically needed alternative therapy for patients with severe aortic stenosis previously refused surgical aortic valve replacement (SAVR). Over 20,000 TAVR have been performed in patients worldwide since 2002 when Alain Cribier performed the first-in-man TAVR. This paper reviews the data from balloon expandable and self-expanding aortic stent valves as well as data comparing them with traditional surgical aortic valve replacement (SAVR). Complications using criteria established by the Valve Academic Research Consortium (VARC) are reviewed. Future challenges and possibilities are discussed and will make optimizing TAVR an important goal in the years to come.

Keywords: Acurate; CoreValve; JenaValve; PARTNER; SAPIEN; SAVR; TAVI; TAVR; VARC; aortic stenosis; complications; review; stent valve; transcatheter; transcatheter aortic valve replacement; valve academic research consortium.

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Figures

Figure 1
Figure 1
Natural history of AS increases dramatically after onset of symptoms; without surgical intervention, mortality increases dramatically. Reprinted with permission. Notes: From the patient perspective, in the past patients had no options if the cardiothoracic surgeons refused to operate. Some would be given comfort care while others would have an aortic valvuloplasty (first described by Dr Alain Cribier in 1986) to temporize the AS. Data suggests that this has no significant effect on long-term survival.
Figure 2
Figure 2
Edwards SAPIEN Valve. Reprinted with permission.
Figure 3
Figure 3
Medtronic CoreValve. Reprinted with permission.
Figure 4
Figure 4
PARTNER trial data showing superior outcomes from TAVI vs. standard therapy for death at 1 and 2 years for: (A) death from any cause, and (B) death from a cardiovascular cause. Reprinted with permission.
Figure 5
Figure 5
Time-to-event curve for stroke. Reprinted with permission.
Figure 6
Figure 6
Position for deployment is an important factor in determining paravalvular regurgitation with the Medtronic CoreValve. Reprinted with permission.
See this image and copyright information in PMC

References

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