Journal Article

Transcatheter aortic valve replacement: when should we say no?

Kennedy, Ciara, Mylotte, Darren, Prabhakar, Akul, Lunardi, Mattia

2022

Overview

Correspondence to Dr Darren Mylotte; [e-mail] Transcatheter aortic valve replacement (TAVR) was born as a last resort for otherwise inoperable patients with symptomatic severe aortic stenosis (AS).1 Initially, the procedure was invasive, associated with serious complications and expensive, but if successful, offered patients with few treatment options the opportunity for improved survival and enhanced quality of life (QoL). With TAVR, the treatment goals are improved survival and reduced symptoms and hence, a poor outcome would include death and reduced QoL post procedure.2 The cornerstone randomised controlled trials of TAVR carefully evaluated objective QoL measures prior to and after TAVR using the Kansas City Cardiomyopathy Questionnaire (KCCQ), a standard measure of symptoms, physical and social limitations, and QoL in patients with heart failure. The reported low incidence of poor SI may be related to several factors: the use of NYHA class as a QoL parameter may reflect the physician’s subjective perspective than that of the patient and could underestimate the patient’s perception.10 Also, the exclusion patients who died within 1 year of TAVR from this analysis likely impacted the low rate of poor SI. [...]the inclusion of first-generation TAVR systems and the analysis being limited to Asian patients could limit the generalisation of such finding to broader populations. The aetiology of the MR was not reported in this study, however, and is a key issue when considering the outcome of patients with coexistent MR undergoing TAVR since the severity of MR has been shown to improve in two-thirds of patients (60%) of cases, mostly attributed to reverse left ventricular remodelling and improved left ventricular function,16 suggesting functional MR aetiology in these patients.

• Publisher: British Cardiovascular Society,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Aged / Aortic stenosis / aortic valve stenosis / Aortic Valve Stenosis - surgery / Cardiac arrhythmia / Chronic obstructive pulmonary disease / Comorbidity / Contraindications / Decision making / Editorial / Female / Frailty / healthcare / Heart failure / Heart Valve Prosthesis / Humans / Illnesses / Kidney diseases / Male / Medical prognosis / outcome assessment / Patients / Transcatheter Aortic Valve Replacement