Transcatheter aortic valve replacement (TAVR) with a self-expanding transcatheter heart valve (THV) is associated with a lower risk of structural valve deterioration (SVD) than other treatment options, according to a new meta-analysis published in the American Journal of Cardiology.
“As subsequent trials continue to demonstrate favorable outcomes of TAVR in intermediate- and low-risk patients, its use is expanding to include a younger population,” wrote lead author Hiroki Ueyama, MD, a specialist at the Icahn School of Medicine at Mount Sinai, and colleagues. “Consequently, the durability of THVs has become a crucial aspect to consider as the life-expectancy of this population is anticipated to extend beyond that of earlier TAVR candidates.”
Ueyama’s team compared TAVR with self-expanding THVs with TAVR with balloon-expandable THVs and surgical aortic valve replacement (SAVR), focusing primarily on durability. The group’s analysis included data from 10 different randomized controlled trials (RCTs).
Overall, reviewing data from more than 9,000 patients, the group found that TAVR—with both self-expanding and balloon-expandable THVs—resulted in “superior forward-flow hemodynamics” compared to SAVR. After five years, the self-expanding THVs were associated with “significantly favorable hemodynamics”, a much larger effective orifice area and a lower mean aortic valve gradient.
One of the group’s biggest takeaways was related to SVD, which was less frequent with TAVR with a self-expanding THV than the other treatment options. However, moderate or severe aortic regurgitation and reintervention were both more frequent among TAVR patients than SAVR patients.
“Although the exact mechanism of this finding is unclear, the difference in material of bioprosthesis, mode of delivery and crimping, and forward-flow hemodynamics likely play a crucial role in valve durability,” the authors wrote.
The study did have certain limitations, including a slightly inconsistent definition of SVD and a lack of real-world data. More long-term data is needed to further explore these trends over time, the authors concluded.
Read the full analysis here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.