Coming to a Consensus on TAVR

Coming to a Consensus on TAVR

In 2011, the FDA approved transcatheter aortic valve replacement (TAVR) for transfemoral use in symptomatic patients with severe aortic stenosis who are not considered candidates for surgery. On behalf of the Society for Cardiovascular Angiography and Interventions, the American College of Cardiology Foundation, the American Association for Thoracic Surgery, and the Society of Thoracic Surgeons, my colleagues and I collaborated to develop an expert consensus document on TAVR. The document, published in a 2012 issue of Journal of the American College of Cardiology, is intended to inform physicians on the most appropriate use of TAVR based on available evidence. The consensus document does not recommend universal use of TAVR because the technology is still being investigated. Instead, we recommend that hospitals eligible to perform TAVR should initially be limited to those that are currently performing an average of at least one aortic valve replacement per week. This means that the 400 busiest cardiac surgery programs would be able to access this technology in the first 2 years following FDA approval. After monitoring outcomes, use of TAVR could be expanded or restricted depending on success and failure rates. A Team Approach to TAVR It’s recommended that territorial and specialty-based decisions on treatment with TAVR be avoided by utilizing a heart team approach. This team should include a surgeon, interventional cardiologist, cardiac anesthesiologist, and an imaging specialist. Allied health professionals—including social workers, nutritionists, and physician assistants— should also be involved. Data from the PARTNER trial, which was the initial regulatory trial for TAVR conducted in the United States, indicate that use of heart team approaches may enhance outcomes. “It’s recommended that...

ACC.12 Highlights for Surgeons

New research was recently presented at ACC.12, the annual scientific meeting of the American College of Cardiology, from March 24-27 in Chicago. The features below highlight just some of the studies that emerged from the meeting that pertain specifically to the surgeon audience.  >> Positive Outcomes Observed With TAVI >> Assessing the Safety of On- & Off-Pump CABG >> TAVR Comparable to Open-Heart Surgery at 2 Years >> Bariatric Surgery Yields Big Rewards for Obese Diabetics >> Underweight Patients at Increased Risk During ICD Procedures >> Improving the Quality of ACS Care       Positive Outcomes Observed With TAVI The Particulars: Transcatheter aortic valve implantation (TAVI) involves insertion of a bioprosthetic valve into a diseased native aortic valve and represents a potentially less invasive option than surgical replacement. Currently, TAVI has been used mostly in non-operable patients. Data Breakdown: A study was conducted in high-risk patients with severe aortic stenosis who underwent TAVI at 44 centers. Major adverse cardiac and cerebrovascular events at 30-days follow-up occurred in 8.3% of patients receiving TAVI. Total mortality, cardiac mortality, stroke, and life-threatening or disabling bleeding rates were 4.5%, 2.2%, 2.9%, and 4.9%, respectively. Persistent, significant improvements in aortic valve function were also observed. Take Home Pearl: In high operative risk and non-operable patients, TAVI appears to be safe and effective. Assessing the Safety of On- & Off-Pump CABG The Particulars: CABG is one of the most commonly performed cardiac operations, but small randomized trials and meta-analyses have yet to determine conclusively if less-invasive off-pump CABG has better outcomes than on-pump CABG. Data Breakdown: A trial of nearly 5,000 patients with coronary artery disease...