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      TAVR: A Review of Current Practices and Considerations in Low-Risk Patients

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          Abstract

          Transcatheter aortic valve replacement (TAVR) is an established treatment for severe, symptomatic, aortic stenosis (AS) in patients of all risk categories and now comprises 12.5% of all aortic valve replacements. TAVR is a less invasive alternative to traditional surgical aortic valve replacement (SAVR), with equivalent or superior outcomes. The use of TAVR has increased rapidly. The success and increase in use of TAVR are a result of advances in technology, greater operator experience, and improved outcomes. Indications have recently expanded to include patients considered to be at low risk for SAVR. While TAVR outcomes have improved, remaining challenges include the management of coexistent coronary artery disease, prevention of periprocedural stroke, and issue of durability. These issues are even more relevant for low-risk, younger patients.

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          Most cited references 75

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          Two-year outcomes after transcatheter or surgical aortic-valve replacement.

          The Placement of Aortic Transcatheter Valves (PARTNER) trial showed that among high-risk patients with aortic stenosis, the 1-year survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical replacement. However, longer-term follow-up is necessary to determine whether TAVR has prolonged benefits. At 25 centers, we randomly assigned 699 high-risk patients with severe aortic stenosis to undergo either surgical aortic-valve replacement or TAVR. All patients were followed for at least 2 years, with assessment of clinical outcomes and echocardiographic evaluation. The rates of death from any cause were similar in the TAVR and surgery groups (hazard ratio with TAVR, 0.90; 95% confidence interval [CI], 0.71 to 1.15; P=0.41) and at 2 years (Kaplan-Meier analysis) were 33.9% in the TAVR group and 35.0% in the surgery group (P=0.78). The frequency of all strokes during follow-up did not differ significantly between the two groups (hazard ratio, 1.22; 95% CI, 0.67 to 2.23; P=0.52). At 30 days, strokes were more frequent with TAVR than with surgical replacement (4.6% vs. 2.4%, P=0.12); subsequently, there were 8 additional strokes in the TAVR group and 12 in the surgery group. Improvement in valve areas was similar with TAVR and surgical replacement and was maintained for 2 years. Paravalvular regurgitation was more frequent after TAVR (P<0.001), and even mild paravalvular regurgitation was associated with increased late mortality (P<0.001). A 2-year follow-up of patients in the PARTNER trial supports TAVR as an alternative to surgery in high-risk patients. The two treatments were similar with respect to mortality, reduction in symptoms, and improved valve hemodynamics, but paravalvular regurgitation was more frequent after TAVR and was associated with increased late mortality. (Funded by Edwards Lifesciences; ClinicalTrials.gov number, NCT00530894.).
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            Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients

            Among patients with aortic stenosis who are at intermediate or high risk for death with surgery, major outcomes are similar with transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve replacement. There is insufficient evidence regarding the comparison of the two procedures in patients who are at low risk.
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              Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients

              Transcatheter aortic-valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis who are at increased risk for death from surgery; less is known about TAVR in low-risk patients.
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                Author and article information

                Contributors
                Journal
                J Interv Cardiol
                J Interv Cardiol
                JITC
                Journal of Interventional Cardiology
                Hindawi
                0896-4327
                1540-8183
                2020
                24 December 2020
                : 2020
                Affiliations
                1Department of Medicine, Pennsylvania Hospital, University of Pennsylvania Health System (UPHS), Philadelphia, PA, USA
                2Department of Cardiology, Pennsylvania Hospital, University of Pennsylvania Health System (UPHS), Philadelphia, PA, USA
                Author notes

                Academic Editor: Sahil Khera

                Article
                10.1155/2020/2582938
                7781688
                Copyright © 2020 Jenna Spears et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Review Article

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