In a trial that many are calling landmark, transcatheter aortic valve replacement had better outcomes than surveillance for patients with severe but asymptomatic aortic stenosis.
with no apparent cost in adverse events, according to the EARLY TAVR study, which was immediately characterized as a landmark by several experts.
In EARLY TAVR, conducted at 75 sites in the United States and Canada, 901 patients with severe aortic stenosis, a left ventricular ejection fraction of at least 50%, and no symptoms of aortic stenosis were randomized. An emphasis was placed on early intervention, and the median time to TAVR after study enrollment was only 14 days. During the follow-up period, those in the surveillance group were followed closely and referred for TAVR as soon as symptoms developed.
Even without a mortality advantage, the favorable effect of TAVR on hospitalization corresponded to a clinically meaningful improvement in quality of life, Généreux reported. On the 12-point Kansas City Cardiomyopathy Questionnaire, the sustained advantage was described as substantial and clinically meaningful.Importantly, there was a steady increase in conversion to symptomatic aortic stenosis among patients in the surveillance group.
After agreeing that"there should be some penalty to pay for being more aggressive," invited expert Jeffrey W. Moses, MD, professor of cardiology at the Columbia University Medical Center, New York City, said he is impressed that there appears to be no downside.
Cardiac Surgery Congenital Heart Disease Aortic Stenosis Stenosis Of The Aorta Valvar Aortic Stenosis Stenosis Pathologic Constriction Transcatheter Aortic Valve Replacement TAVR Transcatheter Aortic Valve Implantation TAVI Percutaneous Aortic Valve Replacement Aortic Valve Valve Replacement Stroke Cerebrovascular Accident CVA - Cerebrovascular Accident
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