June 03, 2021
Accumulating data make clear the detrimental effect of moderate aortic stenosis (AS) in patients who have heart failure with reduced ejection fraction (HFrEF), a new study suggests, and they point toward the potential for improving survival after TAVI.
Compared with patients who had HFrEF but not moderate AS, those with the combination of both had greater risk for mortality at 3 years (HR 2.98; 95% CI 2.08-4.31), as well as for the composite of HF hospitalization and mortality (HR 2.34; 95% CI 1.72-3.21). Additionally, those who had TAVI over the follow-up period survived longer than those on medication alone.
Senior author Marie-Annick Clavel, PhD (Laval University, Quebec, Canada), said the while there is consensus that moderate aortic stenosis is not benign, optimal management for the subset of patients with both HF and moderate aortic stenosis is unclear. However, she said current thinking seems to be moving away from “wait-and-see” approaches to intervention
January 22, 2021
A significant proportion of real-world patients with severe aortic stenosis and low surgical risk have an additional valvular or CV condition that was never accounted for in pivotal trials of TAVI versus SAVR and that requires a serious discussion by the heart team, Canadian research shows.
In the study of primarily low-risk patients who underwent SAVR between 2000 and 2019, 40.8% had at least one of the following conditions: non-tricuspid aortic valve (NTAV), severe coronary artery disease (SevCAD), concomitant mitral/tricuspid valve (CMTV), or concomitant ascending aorta replacement (CAAR). All four of those patient subgroups were routinely excluded from RCTs of TAVI compared with SAVR.