Something is happening in the field of aortic valve stenosis therapy. The previous gold standard seems to be defeated by the results of transvascular aortic valve implantation.
The PARTNER-3 trial enrolled 1000 patients with a median age of 73 years and a low surgical risk. Ultimately, 496 TAVI subjects were treated with a balloon-expandable Edwards Sapien 3 prosthesis and 454 LAD patients were treated with a biological prosthetic valve. The primary end point referred to a composite of death, stroke, and rehospitalization at 12 months.
The primary end point was met by 8.5% of TAVI patients and by 15.1% of LAD patients. This corresponds to a statistically significant risk reduction of 46%. Mortality was also lower in the TAVI group (1%) than in the comparison group (2.5%). The number of strokes was 1.2%, nearly two-thirds lower than the LAD group (3.1%), and the rehospitalization rate was also reduced in favor of TAVI (7.3% vs. 11.0%). In contrast to the previous PARTNER studies, this case did not show a statistically significant difference with regard to a higher pacing rate. In addition, patients recovered significantly faster after the TAVI procedure. A first improvement was perceived after 30 days, while the LFS patients had to wait twelve months.
Customize treatments results
The experts of the DGK consider it necessary to adapt the treatment guidelines to the new data situation as soon as possible and to declare TAVI the gold standard in the treatment of aortic valve stenosis. Age limits should also be critically examined. A reduction to 70 years would be worth considering.
Source: 85th Annual Meeting of the DGK 04/2019
CARDIOVASC 2019; 18(3): 40 (published 7/6/19, ahead of print).
