Outcomes in Patients With Asymptomatic Aortic Stenosis (from the Evolut Low Risk Trial).
Document Type
Article
Publication Title
The American journal of cardiology
Abstract
Transcatheter aortic valve implantation (TAVI) has comparable outcomes with surgical aortic valve replacement (SAVR) in symptomatic patients with severe aortic stenosis, including those at low risk for surgery. Less is known about TAVI outcomes in asymptomatic patients. This analysis compares clinical, hemodynamic, and quality of life (QOL) outcomes after TAVI or SAVR for low-risk asymptomatic patients. The randomized Evolut Low Risk trial enrolled asymptomatic patients treated with TAVI (n = 76) and SAVR (n = 62). New York Heart Association functional class I identified patients without symptoms. Clinical outcomes, echocardiographic findings, and QOL in both groups were compared 30 days and 12 months after AVR. Asymptomatic patients had a mean Society of Thoracic Surgeons score of 1.7 ± 0.6, 73% were men, and mean age was 74.2 ± 5.8 years. The composite end point of all-cause mortality or disabling stroke was similar at 12 months in patients with TAVI (1.3%) and SAVR (6.5%; p = 0.11), although patients with SAVR tended to have higher rates of all-cause mortality (4.8%) compared with patients with TAVI (0.0%, p = 0.05). Patients with TAVI had lower mean aortic valve gradients (8.1 ± 3.2 mm Hg) and larger mean effective orifice area (2.3 ± 0.6 mm Hg) than patients with SAVR (10.8 ± 3.8; p < 0.001 and 1.9 ± 0.6; p = 0.001, respectively), and showed significant improvement in Kansas City Cardiomyopathy Questionnaire scores from baseline to 30 days (∆12.1 ± 23.6; p < 0.001), whereas patients with SAVR did not (∆2.2 ± 20.3; p = 0.398). Patients with TAVI and SAVR had a significant improvement in QOL by 12 months compared with baseline. In conclusion, low risk asymptomatic patients with severe aortic stenosis who underwent TAVI had comparable clinical outcomes to SAVR, with superior valve performance and faster QOL improvement.
First Page
110
Last Page
116
DOI
10.1016/j.amjcard.2021.12.027
Publication Date
4-1-2022
Recommended Citation
Merhi WM, Heiser J, Deeb GM, Yakubov SJ, Lim DS, Bladergroen M, Tadros P, Zorn G 3rd, Byrne T, Kirshner M, Huang J, Reardon MJ. Outcomes in Patients With Asymptomatic Aortic Stenosis (from the Evolut Low Risk Trial). Am J Cardiol. 2022 Apr 1;168:110-116. doi: 10.1016/j.amjcard.2021.12.027. Epub 2022 Jan 31. PMID: 35101271.