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EBM verdict
General medicine
TAVR for low-risk severe aortic stenosis: is this the end of surgical valve replacement?
  1. Robert Thomas Harvey1,
  2. Yash Singbal1,2
  1. 1 Department of Cardiology, Princess Alexandra Hospital Health Service District, Woolloongabba, Queensland, Australia
  2. 2 School of Medicine, University of Queensland, Herston, Queensland, Australia
  1. Correspondence to Dr Robert Thomas Harvey, Cardiology, Princess Alexandra Hospital Health Service District, Woolloongabba, QLD 4102, Australia; Robert.harvey{at}health.qld.gov.au

https://doi.org/10.1136/bmjebm-2019-111259

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    New trials, PARTNER 3 and Evolut Low Risk, showed promising results for transcatheter aortic valve replacement for low-risk surgical patients with severe aortic stenosis. However, there remain caveats to its use in this population in clinical practice.

    Aortic stenosis (AS) is the most common valve disease in developed countries.1 In the absence of valve replacement, severe AS has a 2-year mortality rate of more than 50%.2

    Historically, surgery was the predominant treatment option for severe AS. However, two recent randomised controlled trials have further examined the use of a minimally invasive approach: transcatheter aortic valve replacement (TAVR).

    PARTNER 33 and Evolut Low Risk4 examined the safety and efficacy of TAVR in patients with severe AS at low risk for surgical AVR (SAVR). Patients having open operations can be categorised into low, intermediate and high risk for perioperative mortality using a validated risk-prediction model called the Society of Thoracic Surgery (STS) score.5 PARTNER 3 randomised …

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    Footnotes

    • Contributors Both the authors contributed equally.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.