TAVI Procedure

The procedure of TAVI is straightforward and is quite similar to placing a stent. There are two methods used to access the aortic valve. Using imaging techniques, a catheter may be passed up the femoral artery in the leg (transfemoral approach), or a small incision in the chest can be used to access large vessels in the chest or the left ventricle of the heart (transapical approach).  Once the catheter with the new valve reaches the narrowed aortic valve, a balloon on the catheter’s tip is inflated, and the new valve is appropriately positioned, relieving the narrowing1.

SAVR?

The other alternative to TAVI is open surgery involving a sternotomy, opening up the chest cavity and operating directly on the heart. This is called Surgical Aortic Valve Replacement (SAVR). Up until recently, TAVI was a procedure that was reserved to be used only on patients who fell into the intermediate or high-risk category to undergo surgery. In patients who were at low risk for complications following surgery, the preferred treatment was SAVR.

TAVI vs SAVR – Which is Better?

However, two recent studies, the PARTNER 3 trial and The Evolut Low-Risk trial have shown that even in low-risk patients, TAVI is a preferable option over SAVR. These studies conducted large clinical randomized trials where patients with severe aortic stenosis and low risk for surgery underwent either TAVI or SAVR. Overall, both studies agreed that TAVI was superior to SAVR for clinical outcomes, and there was a remarkable similarity between these two independently carried out studies.

A quick summary of the two studies; the PARTNER 3 trial was conducted over 12 months. It showed that TAVR had a reduced risk of death, stroke, and rehospitalization compared with SAVR (8.5% vs 15.1%) and had shorter days of hospitalization after surgery (3days vs 7 days). TAVR patients also had more rapid improvements in NYHA class of heart failure, 6-minute walk test distance and higher scores in the Kansas City cardiomyopathy Quality of life questionnaire. Life-threatening bleeds were also less with TAVI.

The Evolut low-risk trial was carried out over 24 months, and it showed that death or disabling stroke and rehospitalization even after 2 years was less in TAVI. At 30 days, there was less incidence of stroke, bleeding, acute kidney injury and atrial fibrillation as well.