TAVR Central

• Aortic stenosis, or aortic valve stenosis, occurs when a heart valve does not fully open, narrowing the heart's aortic valve, and reducing and blocking blood flow from the heart’s main artery to the body.
• Among patients with aortic stenosis, the disease is attributable to a bicuspid aortic valve, which is a heart defect where an aortic valve has two vs. three leaflets. More commonly, aortic stenosis develops as a result of aging, when calcium and scarring restrict blood flow.
• Although individuals with aortic stenosis may not develop or notice symptoms, common symptoms include chest pain, fatigue, shortness of breath, heart palpitations or heart murmur, and lightheadedness.
• An analysis of 108,211 individuals linked obesity and higher BMI to an increased risk for aortic stenosis.
• Aortic stenosis mainly affects older individuals, typically after age 60 years, with symptoms occurring around age 70 or 80 years. However, it also can occur in young people, usually among those with bicuspid valves.
• Transcatheter aortic valve replacement, often used to treat and relieve symptoms of aortic stenosis, is a minimally invasive treatment that replaces a narrow aortic valve.
• TAVR is approved for patients with severe symptomatic aortic stenosis in all risk categories.
• TAVR is performed with two typical approaches: the transfemoral approach, which involves entering through the femoral artery, and the transapical approach, which involves entering through a small incision in the chest.
• A study of 932 individuals with bicuspid aortic valve stenosis and 26,154 individuals with tricuspid aortic valve stenosis who underwent TAVR showed that all-cause mortality, valve hemodynamics and stroke were not significantly different between the two groups at 30 days and 1 year after the procedure.
• Due to recently reported results of large, compelling, randomized trials, the 2020 American College of Cardiology/American Heart Association clinical practice guideline on management of patients with valvular heart disease has moved toward recommending TAVR more frequently than in the past.

References

American Heart Association. Aortic stenosis overview. Available at: https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-aortic-valve-stenosis. Accessed April 26, 2021.

American Heart Association. What is TAVR? (TAVI). Available at: https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/understanding-your-heart-valve-treatment-options/what-is-tavr. Accessed April 26, 2021.

American Heart Association. Who’s at risk for aortic stenosis? Available at: https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-aortic-valve-stenosis. Accessed April 26, 2021.

FDA. FDA expands indication for several transcatheter heart valves to patients at low risk for death or major complications associated with open-heart surgery. Available at: https://www.fda.gov/news-events/press-announcements/fda-expands-indication-several-transcatheter-heart-valves-patients-low-risk-death-or-major. Accessed June 22, 2021.

Forrest JK, et al. JACC Cardiovasc Interv. 2020;doi:10.1016/j.jcin.2020.03.022.

Kaltoft M, et al. J Am Coll Cardiol. 2020;doi:10.1016/j.jacc.2019.10.050.

Mayo Clinic. Aortic valve stenosis. Available at: https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/symptoms-causes/syc-20353139. Accessed April 26, 2021.

Mayo Clinic. Transcatheter aortic valve replacement (TAVR). Available at: https://www.mayoclinic.org/tests-procedures/transcatheter-aortic-valve-replacement/about/pac-20384698. Accessed April 26, 2021.

Otto CM, et al. J Am Coll Cardiol. 2020;doi:10.1016/j.jacc.2020.11.035.

Penn Medicine. What is Aortic Valve Stenosis? Available at: https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/aortic-valve-stenosis. Accessed April 26, 2021.