As transcatheter aortic valve replacement (TAVR) procedures gain popularity, especially among younger patients, tracking heart valve performance over long periods of time is more important than ever. Structural valve deterioration (SVD), a key metric for measuring valve durability, was the focus of a new analysis published in the Journal of the American College of Cardiology—and the findings help support the continued use of TAVR as an alternative to surgery.
The study’s authors explored SVD rates after five years in intermediate-risk patients who underwent either TAVR or surgical aortic valve replacement (SAVR) for severe aortic stenosis. Data came from the Medtronic-sponsored PARTNER 2A randomized trial and PARTNER 2 Sapien 3 observational study.
The team explored data from more than 1,400 patients who underwent TAVR with the Sapien XT valve and nearly 900 patients who underwent TAVR with the Sapien 3 valve. Overall, after five years, patients receiving the Sapien 3 valve experienced rates of SVD, SVD-related bioprosthetic valve failure (BVF) and all-cause BVF “not significantly different” to SAVR patients. Meanwhile, the Sapien XT patients had “significantly higher” five-year rates of SVD, SVD-related BVF all-cause BVF.
“The second generation balloon expandable valve prosthesis (Sapien XT) was associated with lower 5-year durability than SAVR, whereas the third generation Sapien 3 prosthesis exhibits midterm durability similar to SAVR, supporting use of the Sapien 3 valve as an alternative to SAVR in patients at high, intermediate, or low surgical risk,” wrote lead author Philippe Pibarot, DVM, PhD, of the Québec Heart & Lung Institute, and colleagues.
Additional research is still needed, Pibarot et al. noted, to gain a more complete understanding of the durability of the third-generation prosthesis after TAVR.
A separate commentary, also published in the Journal of the American College of Cardiology, looked at what these latest findings on valve durability mean going forward. It “seems too early” to flat-out recommend TAVR for all low-risk patients, the authors wrote, but “the body of favorable data for TAVR in addition to the present reassuring data for TAVR durability support the fact that SAVR should not be proposed as the go-to treatment for all young candidates for a bioprosthetic valve.”
“The clinical pathway for aortic stenosis should now make up a valve and vascular computed tomography assessment and a clinical evaluation with both interventional structural cardiologists and cardiothoracic surgeons to predict as accurately as possible the outcomes of the two techniques and individualize the treatment,” wrote lead author Eric Van Belle, MD, PhD, Chu De Lille in France, and colleagues. “Overall, a lifetime plan of care should be discussed with the patient to put in perspective that both techniques are complementary and could be required during his or her lifespan, in the same way that percutaneous coronary intervention and coronary artery bypass graft surgery can be used at different moments for a given patient. Now the ball is in the heart team’s court to use both techniques in a comprehensive manner for the greatest benefit of the patients.”