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| [[File:Siren.gif|30px|link=Aortic stenosis resident survival guide]]|| <br> || <br> | |||
| [[Aortic stenosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | |||
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{{Aortic stenosis}} | {{Aortic stenosis}} | ||
== | ==Early TAVR vs. Clinical Surveillance in Asymptomatic Patients with Severe Aortic Stenosis== | ||
In January 2025, a study compared early transcatheter aortic valve replacement (TAVR) with clinical monitoring in asymptomatic patients with severe aortic stenosis<ref name="pmid39466903">{{cite journal |vauthors=Généreux P, Schwartz A, Oldemeyer JB, Pibarot P, Cohen DJ, Blanke P, Lindman BR, Babaliaros V, Fearon WF, Daniels DV, Chhatriwalla AK, Kavinsky C, Gada H, Shah P, Szerlip M, Dahle T, Goel K, O'Neill W, Sheth T, Davidson CJ, Makkar RR, Prince H, Zhao Y, Hahn RT, Leipsic J, Redfors B, Pocock SJ, Mack M, Leon MB |title=Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis |journal=N Engl J Med |volume=392 |issue=3 |pages=217–227 |date=January 2025 |pmid=39466903 |doi=10.1056/NEJMoa2405880 |url=}}</ref>. Below is a summary of the salient findings, implications, and limitations of the study: | |||
===Findings=== | |||
* Patients who underwent early TAVR demonstrated improved left ventricular and atrial function at the two-year follow-up. | |||
* The TAVR group had a higher probability of favorable outcomes, including survival with stable Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. | |||
* Early TAVR was more effective in reducing mortality, stroke incidence, and unplanned cardiovascular hospitalizations. | |||
===Clinical Surveillance Group=== | |||
* Patients experienced a decline in quality of life before transitioning to valve replacement, but significant improvement was observed within 30 days post-procedure. | |||
* Around 25% of patients required aortic valve replacement within six months, with one-third developing severe symptoms. | |||
* By the two-year mark, more than 70% of patients in the clinical surveillance group had undergone valve replacement. Disease progression remained unpredictable, leading to declining heart function over time. | |||
===Stroke and Mortality Outcomes=== | |||
* Mortality rates were similar in both groups, likely due to close monitoring, and were lower compared to previous studies. | |||
* Stroke incidence was higher in the clinical surveillance group, indicating the need for further research. | |||
===Implications and Limitations=== | |||
* Outcomes in real-world settings may vary, as clinical practice often involves less rigorous monitoring than controlled trials. | |||
* The study exclusively used balloon-expandable valves, limiting its applicability to other valve types. | |||
* Findings primarily apply to low-surgical-risk patients (aged 65 and older) with anatomical suitability for transfemoral TAVR. | |||
* The study cohort consisted predominantly of White individuals, potentially affecting its generalizability to diverse populations. | |||
* The COVID-19 pandemic may have influenced some trial outcomes. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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[[Category:Surgery]] | [[Category:Surgery]] | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
Latest revision as of 21:15, 30 January 2025
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Resident Survival Guide |
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Diagnosis |
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Treatment |
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Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty |
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Transcatheter Aortic Valve Replacement (TAVR) |
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Risk calculators and risk factors for Aortic stenosis future or investigational therapies |
Early TAVR vs. Clinical Surveillance in Asymptomatic Patients with Severe Aortic Stenosis
In January 2025, a study compared early transcatheter aortic valve replacement (TAVR) with clinical monitoring in asymptomatic patients with severe aortic stenosis[1]. Below is a summary of the salient findings, implications, and limitations of the study:
Findings
- Patients who underwent early TAVR demonstrated improved left ventricular and atrial function at the two-year follow-up.
- The TAVR group had a higher probability of favorable outcomes, including survival with stable Kansas City Cardiomyopathy Questionnaire (KCCQ) scores.
- Early TAVR was more effective in reducing mortality, stroke incidence, and unplanned cardiovascular hospitalizations.
Clinical Surveillance Group
- Patients experienced a decline in quality of life before transitioning to valve replacement, but significant improvement was observed within 30 days post-procedure.
- Around 25% of patients required aortic valve replacement within six months, with one-third developing severe symptoms.
- By the two-year mark, more than 70% of patients in the clinical surveillance group had undergone valve replacement. Disease progression remained unpredictable, leading to declining heart function over time.
Stroke and Mortality Outcomes
- Mortality rates were similar in both groups, likely due to close monitoring, and were lower compared to previous studies.
- Stroke incidence was higher in the clinical surveillance group, indicating the need for further research.
Implications and Limitations
- Outcomes in real-world settings may vary, as clinical practice often involves less rigorous monitoring than controlled trials.
- The study exclusively used balloon-expandable valves, limiting its applicability to other valve types.
- Findings primarily apply to low-surgical-risk patients (aged 65 and older) with anatomical suitability for transfemoral TAVR.
- The study cohort consisted predominantly of White individuals, potentially affecting its generalizability to diverse populations.
- The COVID-19 pandemic may have influenced some trial outcomes.
References
- ↑ Généreux P, Schwartz A, Oldemeyer JB, Pibarot P, Cohen DJ, Blanke P, Lindman BR, Babaliaros V, Fearon WF, Daniels DV, Chhatriwalla AK, Kavinsky C, Gada H, Shah P, Szerlip M, Dahle T, Goel K, O'Neill W, Sheth T, Davidson CJ, Makkar RR, Prince H, Zhao Y, Hahn RT, Leipsic J, Redfors B, Pocock SJ, Mack M, Leon MB (January 2025). "Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis". N Engl J Med. 392 (3): 217–227. doi:10.1056/NEJMoa2405880. PMID 39466903 Check
|pmid=value (help).