Minimally Invasive Procedure Offers Alternative to Open-Heart Surgery for Aortic Stenosis

The aortic valve is one of the heart's four valves that manage blood flow by opening and closing at the right times. When the aortic artery narrows, a condition known as aortic stenosis develops, limiting the valve's ability to fully open and thus disrupting the flow of blood within the heart and to the body. Back in 2011, the U.S. Food and Drug Administration gave the green light to a procedure called transcatheter aortic valve replacement (TAVR) for individuals with severe aortic stenosis who are prone to complications from surgery. These days, TAVR and other minimally invasive approaches are increasingly being presented as an alternative to traditional surgery. A recent study now shows that outcomes for patients who had a dysfunctional aortic valve and received a prosthetic one through TAVR were comparable to those who had open-heart surgery five years down the line.

The international multicenter study, which included researchers from Cedars-Sinai (Los Angeles, CA, USA), involved patients from healthcare facilities in the United States, Australia, Canada, Japan, and New Zealand. About 1,000 individuals diagnosed with severe, symptomatic aortic stenosis were randomly selected to undergo either TAVR or open-heart surgery. Of these, 496 were treated with TAVR and 454 had surgery. Notably, all these patients were evaluated as having a low risk of complications from surgery.

The research team closely monitored the patients, conducting assessments before the treatment, immediately after, upon leaving the hospital, 30 days later, six months afterward, and then annually for five years. When it came to the rates of death, stroke, and the need for rehospitalization five years after the treatments, the outcomes for both the TAVR and surgery groups were quite similar. Specifically, 111 out of 496 TAVR patients and 117 out of 454 surgical patients had incidents related to death, stroke, or rehospitalization due to issues with the newly placed valve, the procedure itself, or heart failure. These results are in line with previous trials that had examined the outcomes for TAVR and surgery patients at one, two, and three years after their respective treatments.

“Our data at five years validate that TAVR is a good alternative to open-heart surgery in younger patients with aortic stenosis,” said Raj Makkar, MD, Cedars-Sinai’s vice president of Cardiovascular Innovation and Intervention, associate director of the Smidt Heart Institute and the study’s senior author. “They support routinely offering TAVR, even to patients for whom open-heart surgery wouldn’t pose a high risk.”

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