RT Journal Article
SR Electronic
T1 Impact of aortic valve replacement in symptomatic low-risk patients with less than severe aortic stenosis
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e002297
DO 10.1136/openhrt-2023-002297
VO 10
IS 1
A1 Saki Ito
A1 Roger Laham
A1 Vuyisile T Nkomo
A1 John K Forrest
A1 Michael J Reardon
A1 Stephen H Little
A1 Mubashir Mumtaz
A1 Hemal Gada
A1 Tanvir Bajwa
A1 David Langholz
A1 John Heiser
A1 Atul Chawla
A1 Bart Jenson
A1 Guilherme Attizanni
A1 Alan H Markowitz
A1 Jian Huang
A1 Jae K Oh
YR 2023
UL http://openheart.bmj.com/content/10/1/e002297.abstract
AB Objective To evaluate whether transcatheter or surgical aortic valve replacement (TAVR or SAVR) affects clinical and haemodynamic outcomes in symptomatic patients with moderately-severe aortic stenosis (AS).Methods Echocardiographic evidence of severe AS for enrolment in the Evolut Low Risk trial was based on site-reported measurements. For this post hoc analysis, core laboratory measurements identified patients with symptomatic moderately-severe AS (1.0<aortic valve area (AVA)<1.5 cm2, 3.0<peak velocity<4.0 m/s and 20≤mean gradient (MG) <40 mm Hg). Clinical outcomes were reported through 2 years.Results Moderately-severe AS was identified in 113 out of 1414 patients (8%). Baseline AVA was 1.1±0.1 cm2, peak velocity 3.7±0.2 m/s, MG 32.7±4.8 mm Hg and aortic valve calcium volume 588 (364, 815) mm3. Valve haemodynamics improved following TAVR (AVA 2.5±0.7 cm2, peak velocity 1.9±0.5 m/s and MG 8.4±4.8 mm Hg; p<0.001 for all) and SAVR (AVA 2.0±0.6 cm2, peak velocity 2.1±0.4 m/s and MG 10.0±3.4 mm Hg; p<0.001 for all). At 24 months, the rates of death or disabling stroke were similar (TAVR 7.7% vs SAVR 6.5%; p=0.82). Kansas City Cardiomyopathy Questionnaire overall summary score assessing quality of life improved from baseline to 30 days after TAVR (67.0±20.6 to 89.3±13.4; p<0.001) and SAVR (67.5±19.6 to 78.3±22.3; p=0.001).Conclusions In symptomatic patients with moderately-severe AS, AVR appears to be beneficial. Determination of the clinical and haemodynamic profile of patients who can benefit from earlier isolated AVR needs further investigation in randomised clinical trials.Data are available on reasonable request.