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

Authors
  • Siddique, Saima1
  • Gada, Hemal1
  • Mumtaz, Mubashir A.1
  • Vora, Amit N.1, 2
  • 1 UPMC Pinnacle, 111 S. Front St, Harrisburg, PA, 17101, USA , Harrisburg (United States)
  • 2 Duke University Medical Center, Durham, NC, USA , Durham (United States)
Type
Published Article
Journal
Current Cardiology Reports
Publisher
Springer-Verlag
Publication Date
Nov 28, 2019
Volume
21
Issue
12
Identifiers
DOI: 10.1007/s11886-019-1250-5
Source
Springer Nature
Keywords
License
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Abstract

Purpose of ReviewThis 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 FindingsIn 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.SummaryRecent 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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