Angiologie : Libre accès
Libre accès

Abstrait

Trans catheter Aortic Valve Replacement

Wilbert S Aronow

Transcatheter aortic valve replacement (TAVR) may be performed in non-surgical patients with symptomatic severe calcific aortic stenosis (AS). The United Kingdom Transcatheter Aortic Valve Implantation (TAVI) Registry followed prospectively 870 high-risk patients with a mean age of 82 years, with severe symptomatic AS undergoing 877 TAVI procedures [1]. Survival was 92.9% at 30 days, 78.6% at 1 year, and 73.7% at 2 years [1]. Of 442 persons with severe AS at increased surgical risk, mean age 82 years, 78 were treated with medical management, 107 with aortic valve replacement (AVR), and 257 with TAVI [2]. At 30-month follow-up, adjusted mortality was 49% significantly lower for AVR compared with medical treatment and 62% significantly lower for the TAVI group versus the medical treatment group. At 12 months, 92.3% of AVR patients, 93.2% of TAVI patients, and 70.8% of the medically treated group were New York Heart Association (NYHA) functional class I or II [2].In the Placement of Aortic Transcatheter Valves (PARTNER) trial, 699 high-risk patients with severe AS with a mean age of 84 years were randomized to AVR or TAVI [3]. Mortality was 3.4% for the TAVI group versus 6.5% for the AVR group at 30 days (p not significant) and 24.2% for TAVI patients versus 26.8% for AVR patients at 1 year (p not significant). Major stroke was 3.8% for TAVI patients versus 2.1% for AVR patients at 30 days (p not significant) and 5.1% for TAVI patients versus 2.4% for AVR patients at 1 year (p not significant). Major vascular complications at 30 days were 11.0% for TAVI patients versus 3.2% for AVR patients (p