A team of researchers around the world, led by Dr Charbel Abi Khalil at Weill Cornell Medicine-Qatar (WCM-Q), have demonstrated that aortic valve replacement by transcatheter is more effective than the traditional surgical method.
Aortic valve replacement is a lifesaving procedure that involves replacing a damaged or faulty heart valve with a new one, usually made from synthetic material but occasionally from animal tissue.
The traditional surgical method of replacement is invasive and involves separating the breastbone to provide access to the heart, but from 2002 a minimally invasive procedure emerged that uses a catheter inserted via a blood vessel in the leg or a small incision in the chest to implant the new valve.
Along with his fellow researchers, Dr Khalil, associate professor, Medicine & Genetic Medicine at WCM-Q and a cardiology consultant, analysed data from six trials and 7,022 patients with severe aortic stenosis and were able to show that this newer procedure called transcatheter aortic valve replacement or TAVR has better outcomes for patients than the older surgical procedure called surgical aortic valve replacement or SAVR in terms of mortality rates and other cardiovascular endpoints.
The study looked at outcomes for immediate post-procedural results and two years after the procedure. For the post-procedural results, the data revealed a mean 37% risk reduction for adverse effects following transcatheter placement versus the surgical procedure. There was one important caveat, however, which was that placement by transcatheter was associated with a significantly higher risk of leakage between the heart tissue and the valve than the more invasive surgical option. Nevertheless, the transcatheter procedure resulted in more favourable outcomes in terms of producing a larger ‘effective orifice area’ and more stable pressure gradients on either side of the valve.
Similar trends were observed two years after the procedure. Both techniques were found to be associated with post-operative functional complications, with up to one-third of patients experiencing problems related to a mismatch between the aortic annulus and the size of the orifice required for adequate blood flow, as well as issues with paravalvular regurgitation. Patients who had TAVR had lower risk of patient-prosthesis mismatch than those who had the surgical procedure.
Dr Abi Khalil said, “There is clear evidence that there are many advantages to aortic valve replacement by means of transcatheter insertion over the traditional surgical method, but this is counterbalanced by a significantly increased risk of paravalvular leak. However, it remains to be seen how far recent advances in a new generation of prostheses will address these problems. We believe that future research should focus on discovering the associations between the observed problems with TAVR and clinical outcomes.”
Dr Khaled Machaca, senior associate dean for research, innovations, and commercialisation at WCM-Q said, “This research is aligned with WCM-Q’s commitment to conduct research that is translatable and can impact clinical practice toward better treatments.”
Aortic valve replacement is a lifesaving procedure that involves replacing a damaged or faulty heart valve with a new one, usually made from synthetic material but occasionally from animal tissue.
The traditional surgical method of replacement is invasive and involves separating the breastbone to provide access to the heart, but from 2002 a minimally invasive procedure emerged that uses a catheter inserted via a blood vessel in the leg or a small incision in the chest to implant the new valve.
Along with his fellow researchers, Dr Khalil, associate professor, Medicine & Genetic Medicine at WCM-Q and a cardiology consultant, analysed data from six trials and 7,022 patients with severe aortic stenosis and were able to show that this newer procedure called transcatheter aortic valve replacement or TAVR has better outcomes for patients than the older surgical procedure called surgical aortic valve replacement or SAVR in terms of mortality rates and other cardiovascular endpoints.
The study looked at outcomes for immediate post-procedural results and two years after the procedure. For the post-procedural results, the data revealed a mean 37% risk reduction for adverse effects following transcatheter placement versus the surgical procedure. There was one important caveat, however, which was that placement by transcatheter was associated with a significantly higher risk of leakage between the heart tissue and the valve than the more invasive surgical option. Nevertheless, the transcatheter procedure resulted in more favourable outcomes in terms of producing a larger ‘effective orifice area’ and more stable pressure gradients on either side of the valve.
Similar trends were observed two years after the procedure. Both techniques were found to be associated with post-operative functional complications, with up to one-third of patients experiencing problems related to a mismatch between the aortic annulus and the size of the orifice required for adequate blood flow, as well as issues with paravalvular regurgitation. Patients who had TAVR had lower risk of patient-prosthesis mismatch than those who had the surgical procedure.
Dr Abi Khalil said, “There is clear evidence that there are many advantages to aortic valve replacement by means of transcatheter insertion over the traditional surgical method, but this is counterbalanced by a significantly increased risk of paravalvular leak. However, it remains to be seen how far recent advances in a new generation of prostheses will address these problems. We believe that future research should focus on discovering the associations between the observed problems with TAVR and clinical outcomes.”
Dr Khaled Machaca, senior associate dean for research, innovations, and commercialisation at WCM-Q said, “This research is aligned with WCM-Q’s commitment to conduct research that is translatable and can impact clinical practice toward better treatments.”
