Transcatheter aortic valve replacement (TAVR) has been effective in prohibitive/high-risk patients. Expansion toward intermediate or even low-risk patients has been proposed. A review of recent developments will help understand current trends and issues.
The 5-year results from the PARTNER I trial and 2-year results of the CoreValve US Pivotal Trial, together with national registries, confirmed the long-term efficacy and durability of TAVR. Studies including PARTNER II, ADVANCE, and The German Aortic Valve Registry showed short-to mid-term success in intermediate-risk patients. Comparison of balloon-expandable and self-expanding valves in the CHOICE trial associated specific outcome differences with specific valve types, suggesting a more customized approach in valve selection. Short-term results of newer-generation valves have demonstrated excellent safety and efficacy with improved designs. Studies on TAVR-specific complications, such as conduction block and arrhythmia, paravalvular aortic regurgitation, and stroke, have renewed ideas about their prognosis, treatment, and prevention. Conscious sedation percutaneous TAVR has become more popular, with excellent outcomes and improved cost savings.
TAVR has been accepted as an effective treatment even for intermediate-risk patients. This article aims to review the most recent results and essential issues.
aDepartment of Surgery, Division of Cardiovascular Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
bDepartment of Surgery, Westchester Medical Center, Section of Cardiothoracic Surgery, New York Medical College, Valhalla, New York, USA
cDivision of Cardiac Surgery, Sunnybrook Health Sciences Center, University of Toronto, Ontario, Canada
Correspondence to Gilbert H.L. Tang, MD, MSc, MBA, Westchester Medical Center, 100 Woods Road, Macy 114W, Valhalla, NY 10595, USA. Tel: +1 914 493 8793; fax: +1 914 493 1610; e-mail: TangG@wcmc.com