Research

At the 2019 American College of Cardiology Conference (ACC), results of two studies showing the success of Transcatheter Aortic-Valve Replacements (TAVR) for low-risk patients were presented, sparking a discussion on what the future of aortic valve treatment entails.

Over the past decade, the role of TAVR has evolved tremendously, though the replacement of one’s heart valve remains in the form of an open surgical procedure and has been the preferred method since 1961. With the release of the two recent papers, titled Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients and Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients, the non-invasive procedure may see a huge jump in usage rates as the numbers depict a significant lower risk of death, stroke, or rehospitalization at 1 year with TAVR rather than with surgery.

Almost as minimally invasive as it can get, TAVR comes in the form of a small tubular device, which is then crimped to an even smaller size to be threaded through a blood vessel and into the heart. Once in place, the device expands within the valve to provide biologic leaflets, holding together via a metal alloy to take the place of the original leaflets.

James M. McCabe, MD, FACC
James M. McCabe, MD, FACC
UW Cardiologist Dr. James McCabe led UW Medicine’s contributions to the international trial, sponsored by Edwards’ Lifesciences, believing that “given how positive the trial data are, everyone expects that the FDA indication will change in the near future, making a much bigger population eligible for TAVR”. Typically, TAVR were utilized as an option for high-risk patients in situations where surgery would pose to be life-threatening, restricting TAVR from young and low-risk patients where surgery would still be the recommended path. However, the data is difficult to argue against.

During one of the trials, surgical outcomes were near perfect with a rate of death at 30 days in the 1%. An impressive feat nonetheless, the TAVR had an even lower rate of death at 30 days with a rate of 0.4%. Other life threatening or major bleeding issues also occurred less when patients were treated with TAVR over surgery. Of course, the trial has several limitations, a major one being the results only depict 1-year outcomes so far and has yet to see long-term success.

Only time will tell if TAVR will prove to be a sufficient alternative and possible standard for aortic-valve replacements, but until then we’re proud to help lead the charge in providing safer treatments for our patients.

Congratulations to Dr. McCabe on his work with this trial, and we hope to see how the success of TAVR pans out in the future.

To read more about the trial, visit UW Newsroom’s full article and interview with Dr. McCabe, as well as the published papers on the New England Journal of Medicine.