By Dr Jonathan Shurlock
Edited by Dr Ahmed El-Medany
Transcatheter aortic valve implantation (TAVI) continues to be at the forefront of many discussions at present, particularly in the UK. In addition to wider issues in discussion currently, evidence continues to accumulate in favour of TAVI.
The 3-year follow up results of the Evolut Low Risk trial were presented at the 2023 BCS annual scientific session. The Evolut Low risk trial is a randomised trial assessing for non-inferiority of TAVI compared to surgical aortic valve replacement (SAVR). Professor John Forrest presented data from 1,468 patients across international centres, with a mean age of 74. All participants were required to have a diagnosis of severe symptomatic aortic stenosis and assessed to have low surgical risk, with a predicted risk of no more than 3% within 30 days of intervention.
At 3-year follow-up, there was a mortality of 7.4% in the TAVI group, compared with 10.4% in the SAVR group; a non-significant difference (HR 0.70; 95% CI 0.49-1; p=0.051).
Composite end point of all-cause mortality, disabling stroke, and hospitalisation related to aortic valve intervention was shown to be significantly lower in the TAVI group (13.2%) compared with the SAVR group (16.8%) (HR 0.76; 95% CI 0.58-1; p=0.050). Mild paravalvular regurgitation was seen more frequently in the TAVI group, though this difference disappeared at moderate or greater severity of regurgitation.
The study aims to follow up patients over 10 years, so while the results give some supportive evidence for TAVI in low-risk surgical patients, the decision for appropriate intervention remains complex. If longer term data is supportive of TAVI this may well lead to an increase in TAVI as the first-choice treatment option in the context of low surgical risk. In this case, the number of TAVI cases performed is likely to increase. This is a vital consideration for structural heart teams, including their trainees, when planning and training the future workforce.
See the full study here:
Forrest J, Deeb G, Yakubov S, et al. 3-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis. J Am Coll Cardiol. 2023 May, 81 (17) 1663–1674.
