TAVR may offer benefits for certain heart patients

July 25, 2017 – The procedure could be particularly helpful for patients who have previously undergone heart surgery or who have lung disease.

Transcatheter aortic valve replacement (TAVR), a minimally invasive surgical procedure for aortic stenosis, may offer additional benefits to patients who have undergone heart surgery or who have lung disease.

A study by DCRI researchers found no significant difference in rates of death, stroke, or days alive and out of hospital to one year in intermediate- and high-risk patients treated with TAVR and those receiving surgical aortic valve replacement (SAVR). Patients receiving TAVR were more often discharged directly to home, reflecting a less demanding post-operative recovery.

The study, published in the Journal of the American College of Cardiology, was led by the DCRI’s J. Matthew Brennan, MD, MPH (pictured), associate professor of medicine at the Duke University School of Medicine. This involved a broad cohort of 9,464 intermediate- and high-risk patients in the United States with severe aortic stenosis who were eligible for either TAVR or SAVR. The researchers used data from the Transcatheter Valve Therapies Registry and Society of Thoracic Surgeons National Database linked to Medicare administrative claims for follow-up.

Preliminary results of the study were presented in March this year at the American College of Cardiology 66th annual Scientific Sessions of the American College of Cardiology (ACC), in Washington, D.C.

“Based on our completed analysis, TAVR appears to be safe and effective in patients at moderate and high risk, and may offer additional benefit to patients with prior cardiac surgery and those with significant lung disease, for selected outcomes,” Brennan said. “While the results were reassuring, additional analysis of stroke risk with TAVR suggests that this should be a focus of future monitoring.”

A new, educational website, www.valveadvice.org, has been launched to provide support for patients newly diagnosed with aortic valve disease and their families and caregivers. The content has been developed by a team of patients who have experienced severe aortic valve disease, in collaboration with caregivers, clinicians, and researchers. Later this year, an easy-to-navigate, online decision-assistance tool will be launched on the website. This will support informed treatment decisions that incorporate patient preferences and outcomes of interest.

In addition to Brennan, Duke authors on the JACC paper were: Laine Thomas, PhD; Alice Wang, MD; Felicia L. Graham, MBA; David Dai, PhD; Roland Matsouaka, PhD; Sean O’Brien, PhD; Fan Li, PhD; Michael Pencina, PhD; and Eric Peterson, MD, MPH, FAHA, FACC.

The research and www.valveadvice.org website received funding under a Patient-Centered Outcomes Research Institute (PCORI) Award (CER-1306-04350).