Transcatheter aortic valve replacement: Historical perspectives, current evidence, and future directions

Aaron Horne, Elizabeth A. Reineck, Rani Hasan, Jon R Resar, Matthews Chacko

Research output: Contribution to journalReview article

Abstract

Severe aortic stenosis (AS) results in considerable morbidity and mortality without aortic valve replacement and is expected to increase in prevalence with the aging population. Because AS primarily affects the elderly, many patients with comorbidities are poor candidates for surgical aortic valve replacement (SAVR) and may not be referred. Transcatheter aortic valve replacement (TAVR) has emerged as transformative technology for the management of AS over the past decade. Randomized trials have established the safety and efficacy of TAVR with improved mortality and quality of life compared with medical therapy in inoperable patients, while demonstrating noninferiority and even superiority to SAVR among high-risk operative candidates. However, early studies demonstrated an early penalty of stroke and vascular complications with TAVR as well as increased paravalvular leak as compared with SAVR. Two device platforms have been evaluated and approved for use in the United States: the Edwards SAPIEN and the Medtronic CoreValve. Early studies also suggest cost-effectiveness for TAVR. Ongoing studies are evaluating new iterations of the aforementioned TAVR devices, novel device designs, and applications of TAVR in expanded populations of patients including those with lower risk profiles as well as those with comorbidities that were excluded from early clinical trials. Future improvements in TAVR technology will likely reduce periprocedural and long-term complications. Further studies are needed to confirm device durability over long-term follow-up and explore the applicability of TAVR to broader AS patient populations.

Original languageEnglish (US)
Pages (from-to)414-423
Number of pages10
JournalAmerican Heart Journal
Volume168
Issue number4
DOIs
StatePublished - Oct 1 2014

Fingerprint

Aortic Valve Stenosis
Aortic Valve
Surgical Instruments
Equipment and Supplies
Comorbidity
Population
Technology
Equipment Design
Mortality
Transcatheter Aortic Valve Replacement
Direction compound
Cost-Benefit Analysis
Blood Vessels
Stroke
Quality of Life
Clinical Trials
Morbidity
Safety
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Transcatheter aortic valve replacement : Historical perspectives, current evidence, and future directions. / Horne, Aaron; Reineck, Elizabeth A.; Hasan, Rani; Resar, Jon R; Chacko, Matthews.

In: American Heart Journal, Vol. 168, No. 4, 01.10.2014, p. 414-423.

Research output: Contribution to journalReview article

@article{6168250bd1244fb387f720c91fdfb04a,
title = "Transcatheter aortic valve replacement: Historical perspectives, current evidence, and future directions",
abstract = "Severe aortic stenosis (AS) results in considerable morbidity and mortality without aortic valve replacement and is expected to increase in prevalence with the aging population. Because AS primarily affects the elderly, many patients with comorbidities are poor candidates for surgical aortic valve replacement (SAVR) and may not be referred. Transcatheter aortic valve replacement (TAVR) has emerged as transformative technology for the management of AS over the past decade. Randomized trials have established the safety and efficacy of TAVR with improved mortality and quality of life compared with medical therapy in inoperable patients, while demonstrating noninferiority and even superiority to SAVR among high-risk operative candidates. However, early studies demonstrated an early penalty of stroke and vascular complications with TAVR as well as increased paravalvular leak as compared with SAVR. Two device platforms have been evaluated and approved for use in the United States: the Edwards SAPIEN and the Medtronic CoreValve. Early studies also suggest cost-effectiveness for TAVR. Ongoing studies are evaluating new iterations of the aforementioned TAVR devices, novel device designs, and applications of TAVR in expanded populations of patients including those with lower risk profiles as well as those with comorbidities that were excluded from early clinical trials. Future improvements in TAVR technology will likely reduce periprocedural and long-term complications. Further studies are needed to confirm device durability over long-term follow-up and explore the applicability of TAVR to broader AS patient populations.",
author = "Aaron Horne and Reineck, {Elizabeth A.} and Rani Hasan and Resar, {Jon R} and Matthews Chacko",
year = "2014",
month = "10",
day = "1",
doi = "10.1016/j.ahj.2014.07.017",
language = "English (US)",
volume = "168",
pages = "414--423",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Transcatheter aortic valve replacement

T2 - Historical perspectives, current evidence, and future directions

AU - Horne, Aaron

AU - Reineck, Elizabeth A.

AU - Hasan, Rani

AU - Resar, Jon R

AU - Chacko, Matthews

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Severe aortic stenosis (AS) results in considerable morbidity and mortality without aortic valve replacement and is expected to increase in prevalence with the aging population. Because AS primarily affects the elderly, many patients with comorbidities are poor candidates for surgical aortic valve replacement (SAVR) and may not be referred. Transcatheter aortic valve replacement (TAVR) has emerged as transformative technology for the management of AS over the past decade. Randomized trials have established the safety and efficacy of TAVR with improved mortality and quality of life compared with medical therapy in inoperable patients, while demonstrating noninferiority and even superiority to SAVR among high-risk operative candidates. However, early studies demonstrated an early penalty of stroke and vascular complications with TAVR as well as increased paravalvular leak as compared with SAVR. Two device platforms have been evaluated and approved for use in the United States: the Edwards SAPIEN and the Medtronic CoreValve. Early studies also suggest cost-effectiveness for TAVR. Ongoing studies are evaluating new iterations of the aforementioned TAVR devices, novel device designs, and applications of TAVR in expanded populations of patients including those with lower risk profiles as well as those with comorbidities that were excluded from early clinical trials. Future improvements in TAVR technology will likely reduce periprocedural and long-term complications. Further studies are needed to confirm device durability over long-term follow-up and explore the applicability of TAVR to broader AS patient populations.

AB - Severe aortic stenosis (AS) results in considerable morbidity and mortality without aortic valve replacement and is expected to increase in prevalence with the aging population. Because AS primarily affects the elderly, many patients with comorbidities are poor candidates for surgical aortic valve replacement (SAVR) and may not be referred. Transcatheter aortic valve replacement (TAVR) has emerged as transformative technology for the management of AS over the past decade. Randomized trials have established the safety and efficacy of TAVR with improved mortality and quality of life compared with medical therapy in inoperable patients, while demonstrating noninferiority and even superiority to SAVR among high-risk operative candidates. However, early studies demonstrated an early penalty of stroke and vascular complications with TAVR as well as increased paravalvular leak as compared with SAVR. Two device platforms have been evaluated and approved for use in the United States: the Edwards SAPIEN and the Medtronic CoreValve. Early studies also suggest cost-effectiveness for TAVR. Ongoing studies are evaluating new iterations of the aforementioned TAVR devices, novel device designs, and applications of TAVR in expanded populations of patients including those with lower risk profiles as well as those with comorbidities that were excluded from early clinical trials. Future improvements in TAVR technology will likely reduce periprocedural and long-term complications. Further studies are needed to confirm device durability over long-term follow-up and explore the applicability of TAVR to broader AS patient populations.

UR - http://www.scopus.com/inward/record.url?scp=85027918920&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85027918920&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2014.07.017

DO - 10.1016/j.ahj.2014.07.017

M3 - Review article

C2 - 25262249

AN - SCOPUS:85027918920

VL - 168

SP - 414

EP - 423

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 4

ER -