TAVR Speedier Stenosis Fix Than SAVR in Patients With Prior CABG

By David Douglas

June 27, 2019

NEW YORK (Reuters Health) - In patients who have previously undergone coronary-artery bypass grafting (CABG) and have symptomatic aortic stenosis (AS), transcatheter aortic-valve replacement (TAVR) using the Medtronic Corevalve System may offer advantages over surgical aortic-valve replacement (SAVR).

That's according to a post hoc analysis of the SURTAVI clinical trial, online June 19 in JAMA Cardiology.

"The SURTAVI intermediate-risk trial randomized SAVR against TAVR using the self-expanding valve," Dr. Michael J. Reardon of Houston Methodist DeBakey Heart and Vascular Center, Texas, explained in an email to Reuters Health. "Unique to this trial, it also stratified by the need for coronary revascularization and found that for patients needing coronary revascularization, TAVR was safe and effective. TAVR also led to faster improvement in quality of life and exercise tolerance compared to surgery."

Dr. Reardon and colleagues analyzed data on 136 patients who underwent TAVR and 137 who had SAVR at a mean age of about 76 years. More than 80% in both groups were men and all subjects had severe, symptomatic AS.

Compared with patients undergoing SAVR, the mean index hospital stay was significantly shorter in the TAVR group (5.1 days vs. 9.0 days) and a significantly greater proportion of TAVR patients were discharged directly to home.

At 30 days, quality of life, measured using the Kansas City Cardiomyopathy Questionnaire score, was significantly better in TAVR than in SAVR patients (81.4 vs. 69.7). By one year, scores were similar in both groups.

Also at one year of follow-up, all-cause mortality or disabling stroke was 8.9% in the TAVR group and 6.7% in the SAVR group, a non-significant difference.

The TAVR group showed a significant improvement in the distance walked in 6 minutes (48.3 m versus 16.8 m), possibly due to "TAVR's superior hemodynamics" that "may have facilitated increased transvalvular flow needed for exercise," the researchers speculate.

"Firm conclusions cannot be drawn because of the limited statistical power," they add, but TAVR facilitated "faster improvement in quality of life and more robust exercise tolerance, which persisted at 1-year follow-up."

Dr. Parthasarathy Thirumala of the University of Pittsburgh Medical Center, who studies neurological events after surgical procedures and was not involved in the new analysis, told Reuters Health by email, "Most importantly, patients with intermediate risk who underwent surgery or transcatheter treatment had no difference in outcomes, which included death and stroke."

The SURTAVI trial was funded by Medtronic. Dr. Reardon has financial ties to the company as do other authors, one of whom is an employee.

SOURCE: https://bit.ly/2IMgyJy

JAMA Cardiol 2019.