Superior survival with transcatheter core valve over surgery in high-risk patients with aortic stenosis: Good news for the Heart Team

摘要

Recently, we have witnessed a breakthrough in the field of interventional cardiology. The CoreValve US pivotal trial for high-risk patients with severe aortic stenosis (AS) demonstrated superiority in one-year survival when compared to surgery. For the first time, transcatheter aortic valve replacement (TAVR) outperformed state-of-the art surgical aortic valve replacement (SAVR) in high-risk patients with AS. The results of this pivotal study were presented at the 2014 American College of Cardiology Scientific Meeting and simultaneously published in the New England Journal of Medicine [1 ]. In brief, TAVR was associated with lower rates of all-cause mortality at 1-year in the as-treated and the intention-to-treat analysis (14.2% vs 19.1%, p = 0.04 and 13.9% vs 18.7%, p = 0.04, respectively). In addition, TAVR was associated with similar rates of stroke as compared with SAVR at 30-days (4.9% vs 6.2%, p = 0.46) and at 1-year (8.8% vs 12.6%, p = 0.1). Major vascular complications, however, were higher in the TAVR group (5.9% vs 1.7%, p = 0.003). Clearly these results are good news for the Heart Teams, which now can comfortably provide a less invasive procedure with better outcome to this complex, high-risk subset of patients with severe AS.