Article

Transcatheter aortic valve replacement (TAVR) has been approved in the United
States for intermediate and high-risk patients with severe symptomatic aortic
stenosis. More than 80 000 TAVR procedures have been performed in the United
States and the number is growing every year. Two valve designs are approved in
the United States including the balloon expandable Edwards Sapien prosthesis and
self-expanding CoreValve prosthesis. The PARTNER trial of the Sapien valve,
involving patients who were considered inoperable, reported a 19% absolute risk
reduction in mortality compared with medical therapy, with a number needed to
treat of 5. Randomized controlled trials in patients with high and intermediate
risk of inhospital mortality based on the Society of Thoracic Surgeons score
showed noninferiority of TAVR compared with surgical aortic valve replacement.
Major complications associated with TAVR include a 2% to 3% risk of stroke at 30
d, 8% to 25% risk of permanent pacemaker implantation depending on valve design,
and 6% risk of major vascular complications. There are some concerns regarding
valve durability as this technology is extended to younger patients with lower
risk. Five-year follow-up data from the initial PARTNER trials noted appropriate
valve performance and hemodynamics in survivors; however, longer follow-up is
required to assess the true incidence of structural deterioration. Approximately
one-third of TAVR patients are transferred to a transitional care facility after
TAVR, and more than 50% of the patients are frail. Cardiac rehabilitation has
been reported to be safe in post-TAVR patients and was associated with
significant improvements in exercise capacity, functional independence, and
frailty.

Langue : ANGLAIS