Transcatheter Aortic-Valve Implantation (TAVI) for Patients Without Major Surgery

Aortic Stenosis is characterized as an abnormal narrowing of the Aortic Valve opening and has high levels morbidity and mortality. The Transcatheter Aortic-Valve Implantation (TAVI) procedure was created to help patients who suffer from aortic stenosis and who are not likely candidates for aortic valve replacement. This procedure entails the implantation of a bioprosthetic valve via catheter and is implanted inside of the diseased prosthetic valve; this was supplemented with a pharmacological regiment including blood thinners. Since it was developed in 2002, it has become increasingly popular especially in the cases of high surgical-risk patients. There was a study carried out called the Placement of Transcatheter Aortic-Valve trial, or PARTNER trial that determined the efficacy of the procedure in patients who were not suitable candidates for surgery. This was a multicenter trial that was randomized. There was a strict screening process which resulted in approximately only 12 percent of the 3105 patients initially screened went on to be part of the study. The results of this study supported the fact that the TAVI procedure helped patients who were at high-surgical risk and was in fact a successful alternative. The standard 1-year mortality rate was typically 37.5% but in the TAVI group that number dropped to 25%. Also according to the study, the rate of death from cardiovascular disease was also lower in TAVI in comparison to other standard therapies. The only negative however was that there was more occurrences of strokes in TAVI patients as compared to standard therapies. 

Overall I found this paper interesting as I thought that this alternative to standard therapy yielded better results than what current therapies offer. I am interested in medicine and cardiology, as I interned with a cardiologist while I was in highschool. I think it is especially interesting as it sheds hope to people who are not valid candidates for aortic replacement and who are at high-risk for surgery. Although it might not be a permanent cure, it serves as a step forward and prolongs life for those patients, especially in the elderly. 2% of people aged over 60 are affected by this problem and many of the elderly might not be in great shape for a aortic replacement. Therefore I believe that this study seems promising for such patients and will hopefully shed light to the future and lead to further breakthroughs against aortic stenosis. 

SOURCE:  http://www.nejm.org/doi/full/10.1056/NEJMoa1008232#t=article