Featured Research

from universities, journals, and other organizations

Surgical aortic valve replacement should remain the standard treatment for aortic stenosis, expert says

Date:
October 20, 2010
Source:
Boston University Medical Center
Summary:
Despite the promising results of the "Placement of Aortic Transcatheter Valves (PARTNER) trial," a cardiothoracic surgeon from Boston Medical Center believes that surgical aortic-valve replacement should remain the standard treatment of aortic stenosis. In an accompanying editorial, the author argues that transcatheter aortic-valve implantation should be reserved for patients at inordinately high risk who are not suitable candidates for surgery and who have decreased life expectancy.

Despite the promising results of the "Placement of Aortic Transcatheter Valves (PARTNER) trial," featured in the Oct. 21 issue of the New England Journal of Medicine, a cardiothoracic surgeon from Boston Medical Center (BMC) believes that surgical aortic-valve replacement should remain the standard treatment of aortic stenosis. In the accompanying editorial, the author argues that transcatheter aortic-valve implantation (TAVI) should be reserved for patients at inordinately high risk who are not suitable candidates for surgery and who have decreased life expectancy.

Aortic-valve replacement is the most effective treatment to alleviate symptoms and improve survival in patients with critical aortic stenosis. However, a substantial number of these patients have coexisting conditions that preclude surgery. Since outcomes with medical management are poor, a less invasive and safer alternative to surgical aortic valve replacement is needed for this expanding group of patients.

TAVI has emerged as an alternative treatment for aortic stenosis in patients who are considered to have a high or prohibitive surgical risk. In this week's journal, Martin B. Leon and his coauthors report the results of the PARTNER trial, a prospective, randomized, multicenter trial to determine the optimal method of treating patients with critical aortic stenosis who are considered not to be suitable candidates for surgery. Patients who underwent TAVI as compared with patients receiving medical management, had a significantly lower rate of death at one year, fewer hospital readmissions, and a reduction in cardiac symptoms. These improved outcomes were achieved, however, at the cost of a significant increase in the rate of major strokes and vascular events.

"Now that there is evidence-based clinical data to substantiate the benefits of TAVI in patients who are not suitable candidates for surgery, there will be a temptation to expand this technology to all patients with aortic stenosis," said editorial author Harold Lazar, MD, a professor of cardiothoracic surgery and Director of the Cardiothoracic Surgical Laboratories at the Boston University School of Medicine (BUSM).

According to Lazar a number of issues must be resolved prior to deciding what role TAVI may play in the treatment of aortic stenosis including criteria to determine who is not a candidate for surgical aortic-valve replacement, who should perform TAVI and where should it be performed. "Only when these issues are addressed can we determine where we go from here," he stressed.

"Given what we know, TAVI should not be performed in patients with long life expectancies. Prospective, adequately powered, randomized trials comparing TAVI with surgical aortic-valve replacement in both high-risk and low-risk patients will be necessary to further define the role of TAVI in the treatment of aortic stenosis," he added.


Story Source:

The above story is based on materials provided by Boston University Medical Center. Note: Materials may be edited for content and length.


Journal References:

  1. Martin B. Leon, Craig R. Smith, Michael Mack, D. Craig Miller, Jeffrey W. Moses, Lars G. Svensson, E. Murat Tuzcu, John G. Webb, Gregory P. Fontana, Raj R. Makkar, David L. Brown, Peter C. Block, Robert A. Guyton, Augusto D. Pichard, Joseph E. Bavaria, Howard C. Herrmann, Pamela S. Douglas, John L. Petersen, Jodi J. Akin, William N. Anderson, Duolao Wang, Stuart Pocock. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. New England Journal of Medicine, 2010; 363 (17): 1597 DOI: 10.1056/NEJMoa1008232
  2. Harold L. Lazar. Transcatheter Aortic Valves — Where Do We Go from Here? New England Journal of Medicine, 2010; 363 (17): 1667 DOI: 10.1056/NEJMe1009405

Cite This Page:

Boston University Medical Center. "Surgical aortic valve replacement should remain the standard treatment for aortic stenosis, expert says." ScienceDaily. ScienceDaily, 20 October 2010. <www.sciencedaily.com/releases/2010/10/101020171600.htm>.
Boston University Medical Center. (2010, October 20). Surgical aortic valve replacement should remain the standard treatment for aortic stenosis, expert says. ScienceDaily. Retrieved August 2, 2014 from www.sciencedaily.com/releases/2010/10/101020171600.htm
Boston University Medical Center. "Surgical aortic valve replacement should remain the standard treatment for aortic stenosis, expert says." ScienceDaily. www.sciencedaily.com/releases/2010/10/101020171600.htm (accessed August 2, 2014).

Share This




More Health & Medicine News

Saturday, August 2, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Texas Quintuplets Head Home

Texas Quintuplets Head Home

Reuters - US Online Video (Aug. 1, 2014) After four months in the hospital, the first quintuplets to be born at Baylor University Medical Center head home. Linda So reports. Video provided by Reuters
Powered by NewsLook.com
Ebola Patient Coming to U.S. for Treatment

Ebola Patient Coming to U.S. for Treatment

Reuters - US Online Video (Aug. 1, 2014) A U.S. aid worker infected with Ebola while working in West Africa will be treated in a high security ward at Emory University in Atlanta. Linda So reports. Video provided by Reuters
Powered by NewsLook.com
Ebola Vaccine Might Be Coming, But Where's It Been?

Ebola Vaccine Might Be Coming, But Where's It Been?

Newsy (Aug. 1, 2014) Health officials are working to fast-track a vaccine — the West-African Ebola outbreak has killed more than 700. But why didn't we already have one? Video provided by Newsy
Powered by NewsLook.com
Study Links Certain Birth Control Pills To Breast Cancer

Study Links Certain Birth Control Pills To Breast Cancer

Newsy (Aug. 1, 2014) Previous studies have made the link between birth control and breast cancer, but the latest makes the link to high-estrogen oral contraceptives. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins