Over the past decade, one of the Holy Grails for cardiologists (who really won't be satisfied until they see all the cardiac surgeons applying for jobs as beer vendors at sporting events) has been gaining the ability to replace cardiac valves by means of a catheter procedure, thus obviating the need for open chest surgery. This week, the New England Journal of Medicine published early results from the PARTNER trial, which compared results between transcatheter aortic valve implantation (TAVI) and "usual therapy" in patients with aortic stenosis who were deemed too sick to have valve replacement surgery. ("Usual therapy" in these unfortunate patients is limited to medical therapy, which has only very limited benefit in patients with severe aortic stenosis.)
The results showed a significant improvement in survival at one year for the TAVI patients (about 31% had died at one year, compared to 51% of the "usual therapy" patients), and also a reduction in the need for hospitalization. However, TAVI patients had a significantly higher 30-day risk of major strokes, major vascular complications, and major bleeding episodes than did the "usual therapy" patients.
The bottom line is that, in these very sick patients, at the cost of many more major complications during the first month, overall survival was significantly improved with TAVI.
It would therefore appear that TAVI is a viable option for patients with severe aortic stenosis who are simply too sick for surgical valve replacement. However, it is a viable option only because their outlook is so very bleak with usual, non-surgical therapy. Additional studies are ongoing to assess whether TAVI might be a reasonable alternative for patients with aortic stenosis who are somewhat less sick than the patients in this study.
Sources:
Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; DOI:10.1056/NEJMoa1008232.
