Transcatheter vs. surgical aortic valve replacement in patients at intermediate surgical risk

Authors

Nichole M. Bonzano, James Madison UniversityFollow
David M. Milligram, James Madison UniversityFollow

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Course Instructor

Abby Massey

Capstone Semester

Fall 2020

Date of Graduation

12-18-2020

Abstract

Abstract

• Objective: To compare the safety and efficacy of transcatheter aortic valve replacement (TAVR) to surgical aortic valve replacement (SAVR) in patients with severe symptomatic aortic stenosis at intermediate surgical risk.
• Design: Systematic literature review.
• Methods Literature searches were done in PubMed and Scopus search engines using key terms: TAVR, trans-catheter aortic valve replacement, SAVR, surgical aortic valve replacement, severe aortic stenosis, and intermediate risk. Filters included primary research only. Inclusion criteria were articles which studied an intermediate risk patient population (STS-PROM 3-15%), primary research, and compared outcomes of TAVR and SAVR in patients with severe aortic stenosis requiring replacement.
• Results: Two randomized control trials were identified (Reardon et al & Leon et al). One propensity matched retrospective cohort study was identified (Brennan et al).
• Conclusion: The side effect profile for both TAVR and SAVR are very different. TAVR shows higher rates of major vascular complications, pacemaker implantation, and risk of valvular regurgitation while patients undergoing SAVR experience greater rates of blood loss, kidney injury, atrial fibrillation and longer stays in the hospital and ICU. In patients at intermediate risk for surgery, the decision to undergo TAVR or SAVR should be based on the individual patient’s desired outcome. Both procedures show improved quality of life however TAVR has less risk for serious intraoperative complication and reduced recovery time while SAVR shows greater efficacy with less frequent paravalvular regurgitation, need for reintervention and pacemaker implantation.

Document Type

Capstone

Recommended Citation

Bonzano NM, Milligram DM. Transcatheter vs. Surgical Aortic Valve Replacement in Patients at Intermediate Surgical Risk. Posted online December 14, 2020.