Surgical aortic valve replacement should remain the standard treatment for aortic stenosis

Oct 20, 2010

Despite the promising results of the "Placement of Aortic Transcatheter Valves (PARTNER) trial," featured in the Oct. 21 issue of the New England Journal of Medicine, a cardiothoracic surgeon from Boston Medical Center (BMC) believes that surgical aortic-valve replacement should remain the standard treatment of aortic stenosis. In the accompanying editorial, the author argues that Transcatheter aortic-valve implantation (TAVI) should be reserved for patients at inordinately high risk who are not suitable candidates for surgery and who have decreased life expectancy.

Aortic-valve replacement is the most effective treatment to alleviate symptoms and improve survival in patients with critical . However, a substantial number of these patients have coexisting conditions that preclude surgery. Since outcomes with medical management are poor, a less invasive and safer alternative to surgical is needed for this expanding group of patients.

TAVI has emerged as an alternative treatment for aortic stenosis in patients who are considered to have a high or prohibitive surgical risk. In this week's Journal, Martin B. Leon and his coauthors report the results of the PARTNER trial, a prospective, randomized, multicenter trial to determine the optimal method of treating patients with critical aortic stenosis who are considered not to be suitable candidates for surgery. Patients who underwent TAVI as compared with patients receiving medical management, had a significantly lower rate of death at one year, fewer hospital readmissions, and a reduction in cardiac symptoms. These improved outcomes were achieved, however, at the cost of a significant increase in the rate of major strokes and vascular events.

"Now that there is evidence-based clinical data to substantiate the benefits of TAVI in patients who are not suitable candidates for surgery, there will be a temptation to expand this technology to all patients with aortic stenosis," said editorial author Harold Lazar, MD, a professor of cardiothoracic surgery and Director of the Cardiothoracic Surgical Laboratories at the Boston University School of Medicine (BUSM).

According to Lazar a number of issues must be resolved prior to deciding what role TAVI may play in the treatment of aortic stenosis including criteria to determine who is not a candidate for surgical aortic-valve replacement, who should perform TAVI and where should it be performed. "Only when these issues are addressed can we determine where we go from here," he stressed.

"Given what we know, TAVI should not be performed in patients with long life expectancies. Prospective, adequately powered, randomized trials comparing TAVI with surgical aortic-valve replacement in both high-risk and low-risk patients will be necessary to further define the role of TAVI in the treatment of aortic stenosis," he added.

Explore further: Flu season, early again, hitting hard in South and Midwest

Provided by Boston University Medical Center

not rated yet
add to favorites email to friend print save as pdf

Related Stories

Heart valves implanted without open-heart surgery

Jan 07, 2009

An innovative approach for implanting a new aortic heart valve without open-heart surgery is being offered to patients at NewYork-Presbyterian Hospital/Columbia University Medical Center. Known as the PARTNER (Placement of ...

Major discovery in the treatment of aortic valve stenosis

Apr 18, 2008

A team of scientists from the Université de Montréal and the Montreal Heart Institute Research Centre, led by Dr. Jean-Claude Tardif, has completed an important study that show how a new type of medication can lead to an ...

Few complications one year after aortic valve implantation

Sep 21, 2009

Research presented at the 21st annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, sponsored by the Cardiovascular Research Foundation (CRF), demonstrated an "exceptionally low" rate of complications ...

Recommended for you

Evidence-based recs issued for systemic care in psoriasis

19 hours ago

(HealthDay)—For appropriately selected patients with psoriasis, combining biologics with other systemic treatments, including phototherapy, oral medications, or other biologic, may result in greater efficacy ...

Bacteria in caramel apples kills at least four in US

19 hours ago

A listeria outbreak believed to originate from commercially packaged caramel apples has killed at least four people in the United States and sickened 28 people since November, officials said Friday.

Steroid-based treatment may answer needs of pediatric EoE patients

20 hours ago

A new formulation of oral budesonide suspension, a steroid-based treatment, is safe and effective in treating pediatric patients with eosinophilic esophagitis (EoE), according to a new study in Clinical Gastroenterology and Hepatology, the official clinical practice journal ...

Discovery of genes that predispose a severe form of COPD

22 hours ago

A study by Ramcés Falfán-Valencia, researcher at the National Institute of Respiratory Diseases (INER), found that the mestizo Mexican population has a number of variations in certain genes that predispose ...

On the environmental trail of food pathogens

23 hours ago

Tracking one of the deadliest food contamination organisms through produce farms and natural environments alike, Cornell microbiologists are showing how to use big datasets to predict where the next outbreak could start.

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.