Elderly patients once considered too frail or tool sick for aortic valve replacement surgery are living longer, with better quality of life, following a minimally invasive surgery, compared to patients who did not undergo surgery.
Researchers at 21 medical centres followed 358 patients with severe aortic stenosis for five years. The patients, with a mean age of 83, were evenly divided into two study groups – one that underwent minimally invasive trans-catheter aortic valve replacement (TAVR) surgery and one that followed standard therapy, which involved balloon aortic valvuloplasty but no surgery.
Those undergoing TAVR lived longer, with better symptom management, fewer hospital re-admissions and better functional status. At the five-year mark, 28.2% of the TAVR group were still alive, compared to only 6.4% of those undergoing standard therapy.
"This trial is the first – and will probably be the only – randomised aortic stenosis trial that includes a group of patients not treated with aortic valve replacement, since these results will make it unethical to treat severe aortic stenosis patients with medical therapy alone," said Dr Samir Kapadia, the study's primary author and director of the Sones Cardiac Catheterisation Laboratories at Cleveland Clinic.
Aortic stenosis is the most common heart valve disease, causing the aortic valve not to open fully and decreasing blood flow from the heart. For decades, the gold standard treatment was considered aortic valve replacement, though many older patients in their 80s and 90s were considered too sick or too frail to undergo the rigorous surgery. For those patients, TAVR became an option. This study was the first to compare five-year TAVR outcomes with standard therapy.
[link url="http://www.eurekalert.org/pub_releases/2015-03/cc-eas031315.php"]Cleveland Clinic material[/link]
[link url="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60308-7/abstract"]The Lancet article summary[/link]