Clinical trends in surgical, minimally invasive and transcatheter aortic valve replacement†.
OBJECTIVE
Transcatheter aortic valve replacement (TAVR) and minimally invasive aortic valve replacement (MIAVR) have emerged as alternatives to surgical aortic valve replacement (SAVR) via traditional sternotomy. However, their effect on clinical practice remains unclear. The study's objective is to describe clinical trends between TAVR, MIAVR and SAVR in patients with severe aortic stenosis (AS).


METHODS
This retrospective observational study analyzed trends in isolated severe aortic valve replacement (AVR) among three high volume TAVR, MIAVR and SAVR centres in the United States. The cohort included 2571 patients from 2011 through 2014 undergoing SAVR ( n  = 842), MIAVR ( n  = 699) and TAVR ( n  = 1030) further stratified into transapical (TA-TAVR) and trans-femoral (TF-TAVR).


RESULTS
Total AVR volume increased +107% with increases in TF-TAVR (+595%) and MIAVR (+57%). However, SAVR (-15%) and TA-TAVR (-49%) decreased from 2013 to 2014. In the final year, risk stratification by age ≥ 80, redo AVR, patients receiving dialysis and STS score >8% revealed increases in TF-TAVR and MIAVR, while SAVR decreased for all groups.


CONCLUSIONS
TF-TAVR and MIAVR increased while SAVR and TA-TAVR trended down in the latter periods, which underscore a paradigm shift in the treatment of severe AS and the importance of surgeon adoption of TF-TAVR and MIAVR techniques. As the demand for minimally invasive modalities increases, further studies comparing MIAVR versus TF-TAVR in low and intermediate risk patients are warranted.
Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Memorial Hermann Hospital - Heart and Vascular Institute, Houston, TX, USA.
Tom C
TC
Nguyen
Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Memorial Hermann Hospital - Heart and Vascular Institute, Houston, TX, USA.
Matthew D
MD
Terwelp
Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Vinod H
VH
Thourani
Department of Internal Medicine, Division of Cardiology, University of Texas Medical School at Houston, Memorial Hermann Hospital - Heart and Vascular Institute, Houston, TX, USA.
Yelin
Y
Zhao
Department of Internal Medicine, Division of Cardiology, University of Texas Medical School at Houston, Memorial Hermann Hospital - Heart and Vascular Institute, Houston, TX, USA.
Nidal
N
Ganim
Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Memorial Hermann Hospital - Heart and Vascular Institute, Houston, TX, USA.
Carson
C
Hoffmann
Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Memorial Hermann Hospital - Heart and Vascular Institute, Houston, TX, USA.
Monica
M
Justo
Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Memorial Hermann Hospital - Heart and Vascular Institute, Houston, TX, USA.
Anthony L
AL
Estrera
Department of Internal Medicine, Division of Cardiology, University of Texas Medical School at Houston, Memorial Hermann Hospital - Heart and Vascular Institute, Houston, TX, USA.
Richard W
RW
Smalling
Department of Internal Medicine, Division of Cardiology, University of Texas Medical School at Houston, Memorial Hermann Hospital - Heart and Vascular Institute, Houston, TX, USA.
Prakash
P
Balan
Department of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA.
Joseph
J
Lamelas
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation; D015992:Body Mass Index; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020521:Stroke; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends
Aortic valve replacement ; Minimally invasive ; Transcatheter