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Should All Low-risk Patients Now Be Considered for TAVR? Operative Risk, Clinical, and Anatomic Considerations

  • Valvular Heart Disease (TL Kiefer, Section Editor)
  • Published:
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Abstract

Purpose of Review

This article reviews the current data on TAVR in low-risk patients with severe, symptomatic aortic stenosis, highlights the results of the recently published Medtronic Low Risk Randomized Study and PARTNER 3 trials, and describes specific clinical, anatomic, and procedural considerations regarding the optimal treatment choice in this population.

Recent Findings

In low-risk patients, the Medtronic Low Risk Randomized Study demonstrated TAVR to be non-inferior to surgery with respect to the composite endpoint of death or disabling stroke while PARTNER 3 trial proved TAVR to be superior to surgery with regard to the composite endpoint of death, stroke, or rehospitalization.

Summary

Recent trials demonstrate the safety and efficacy of TAVR in low-risk patients and have led to an FDA indication for the use of TAVR in these patients. However, the lack of long-term data on the rate of transcatheter valve deterioration in the younger population, higher incidence of paravalvular leak and pacemaker implantation following TAVR, along with certain intrinsic anatomic factors remain potential challenges to generalize TAVR in all low surgical risk patients. We describe specific clinical, anatomic, and procedural considerations regarding the optimal treatment choice for low-risk patients with severe, symptomatic AS.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. UPMC Pinnacle, 111 S. Front St, Harrisburg, PA, 17101, USA

    Saima Siddique, Hemal Gada, Mubashir A. Mumtaz & Amit N. Vora

  2. Duke University Medical Center, Durham, NC, USA

    Amit N. Vora

Authors
  1. Saima Siddique
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  2. Hemal Gada
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Corresponding author

Correspondence to Amit N. Vora.

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Conflict of Interest

Saima Siddique has no relevant disclosures.

Hemal Gada reports consulting for Medtronic, Bard Inc., Abbott Vascular, and Boston Scientific Corp.

Mubashir A. Mumtaz reports consulting and proctoring for Abbott, Edwards Lifesciences, Medtronic, Atricure, Medtronic, Z-Medica, and JOMDD.

Amit N. Vora reports consulting for Medtronic.

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Siddique, S., Gada, H., Mumtaz, M.A. et al. Should All Low-risk Patients Now Be Considered for TAVR? Operative Risk, Clinical, and Anatomic Considerations. Curr Cardiol Rep 21, 161 (2019). https://doi.org/10.1007/s11886-019-1250-5

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  • DOI: https://doi.org/10.1007/s11886-019-1250-5

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