TAVR comparable to surgery for patients with rheumatic aortic stenosis

Transcatheter aortic valve replacement (TAVR) is as safe and effective as surgery for the treatment of patients with rheumatic aortic stenosis (AS), according to new findings published in the Journal of the American College of Cardiology.

Questions remain about TAVR’s role as a treatment for rheumatic AS, the authors explained. This is because patients with rheumatic AS are typically excluded from clinical trials, and it’s a relatively rare condition in much of the world. The team hoped its analysis could provide new insights and help close that knowledge gap.

Researchers used ICD-10 codes to track the outcomes of more than 1,000 Medicare patients with rheumatic AS who underwent TAVR or surgical aortic valve replacement (SAVR) from October 2015 to December 2017. Data was also evaluated from nearly 90,000 patients with nonrheumatic AS who underwent TAVR during the same timeframe.

Overall, after a median follow-up period of 19 months, there was “no difference” in all-cause mortality between rheumatic AS patients who underwent TAVR and SAVR. Mortality was also similar when comparing TAVR in rheumatic AS patients and in nonrheumatic AS patients.

No rheumatic TAVR patients had to later undergo repeat aortic valve replacement (AVR). Fewer than 11 SAVR patients and nearly 250 nonrheumatic TAVR patients underwent repeat AVR.

“Our study is the largest to date to highlight the feasibility of TAVR patients with rheumatic AS,” wrote lead author Amgad Mentias, MD, of the Cleveland Clinic Foundation’s Heart and Vascular Institute, and colleagues. “Although one could expect inferior technical success with TAVR in those patients … the lack of need for repeat AVR after TAVR in our population is encouraging. Furthermore, the similar outcomes with TAVR for rheumatic versus nonrheumatic AS confirm the safety and feasibility of TAVR in this group.”

While Mentias et al. did praise the potential of TAVR as a “less invasive intervention” for individuals in developing countries, the team also noted that more research is needed on TAVR valve durability before “widespread use in this relatively younger population.”

Read the full analysis here.