TAVI Is a Reasonable Option for High-Risk Elderly Patients

Transcatheter aortic valve implantation benefits patients with severe symptomatic aortic stenosis

THURSDAY, May 3 (HealthDay News) -- For high-risk elderly patients with aortic stenosis, transcatheter aortic-valve implantation (TAVI) is a reasonable option, according to a study published in the May 3 issue of the New England Journal of Medicine.

Martine Gilard, M.D., Ph.D., from the Centre Hospitalier Universitaire Brest in France, and colleagues reported the results of a prospective multicenter study involving 3,195 elderly patients (mean age, 82.7 years) who underwent TAVI in France between January 2010 and October 2011. All participants were highly symptomatic and had a high surgical risk for aortic-valve replacement.

The investigators note that Edwards SAPIEN devices were implanted into 66.9 percent of patients and Medtronic CoreValve devices in 33.1 percent; they observed a success rate of 96.9 percent for the procedure. The approaches were transapical (17.8 percent), or transarterial (transfemoral, 74.6 percent; subclavian, 5.8 percent; or other, 1.8 percent). The rates of 30-day and one-year mortality were 9.7 and 24 percent, respectively. The incidence of stroke and periprosthetic aortic regurgitation at one-year was 4.1 and 64.5 percent, respectively. A higher logistic risk score on the European System for Cardiac Operative Risk Evaluation, New York Heart Association functional class III or IV symptoms, a transapical approach, and a higher amount of periprosthetic regurgitation correlated significantly with decreased survival in a multivariate model.

"TAVI is a new therapeutic option for high-risk patients with severe aortic stenosis," the authors write. "Further progress in patient-selection criteria, postprocedural care, and choice of optimal access are essential for improving results."

The study was funded by Edwards Lifesciences and Medtronic; several authors disclosed financial ties to these and other medical device companies.

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