Editor: Jiamo Ren
Transcatheter aortic valve implantation (TAVI) has developed into the standard treatment option for patients with severe aortic stenosis, but as TAVI expands to younger, lower-risk patients with longer life expectancies, which patients should After surgical aortic valve replacement (SAVR), what are the long-term outcomes of TAVI and SAVR worth considering? At the ESC 2022 conference, this magazine specially invited Professor Didier Tchetche from the Pasteur Clinic in France to conduct an exclusive interview.
International Circulation:As the Chairman of the special session "The End of Lifetime Management of SAVR and TAVR", Would you please introduce the background and significance of this topic?
Professor Didier Tchetche: This session was a very important session because it deals with a contemporary concern that we have. As we are now allowed in Europe to treat slightly younger patients than we did in the past, the issue arises of the lifetime management of these patients. The choice of the first therapy, whether it be surgery or TAVI, has consequences. This session was about discussing the pros and cons of the various options, integrating the will of the patient, the background of the patient, and what we anticipate to be the future outcomes for the patient.
International Circulation: In intermediate-risk patients with severe aortic stenosis and chronic kidney disease, what are the differences in outcomes between TAVI and SAVR?
Professor Didier Tchetche: This is quite an important topic. We know that in intermediate risk patients, TAVI has similar outcomes to surgery, but when we put into the equation the issue of renal function, this has an impact on our choices. For patients with renal failure who are going to have a device, for instance, a surgical valve that is going to degenerate faster, and maybe the same for TAVI, we need to integrate that with the life expectancy of the particular patient. They may be at intermediate risk, but the degree of the renal disease (whether the patient is on dialysis and so on) will have an impact on the anticipated durability of the platform that is going to be utilized. For the time being, potentially in intermediate risk patients, if we have peripheral vascular disease that may preclude safe advancement of the delivery catheter for TAVI, surgery would be the choice. Otherwise, TAVI would be the better choice for patients of intermediate risk. It is an issue of access.
International Circulation: What factors should be considered when choosing TAVI or SAVR in intermediate risk patients?
Professor Didier Tchetche: In intermediate risk patients, as proven by the literature, we know that outcomes are similar for transfemoral TAVI and surgery in intermediate risk patients. They produce the same outcomes. So it is going to come down to the anatomy of the patient. Where we understand the transfemoral anatomy, we know we can safely treat these patients with TAVI. If we have more challenging anatomy, such as, for instance, bicuspid aortic valves, ascending aorta aneurysms, small aortic roots, more challenging peripheral vasculature, then potentially surgery has advantages compared to TAVI.
Comments
Post a Comment