TAVR VS SAVR IN LOW-RISK AORTIC STENOSIS PATIENTS MEDTRONIC CORE VALVE EUROPEAN STUDY 5 YEAR FOLLOW UP RESULTS

1. Thyregod HGH.

2. Dr.Alain Cribier
April 16th 2002
A 57-year-old patient with severe AS presented in
cardiogenic shock with major left ventricular dysfunction
(the ejection fraction was 12%!)

5. TAVR = SAVR
TAVR = SAVR
TAVR = SAVR 
Futile

6. STS PROM
SCORE
Logistic
EURO
SCORE
Very high risk >15%
High Risk >8% -15% >20%
Intermediate
Risk
4-8% 10-20%
Low risk <4% <10%
Logistic EuroSCORE II
• Better than EuroSCORE I,
(overestimates risk)
• well compared with the STS risk score.
• more flexibility than the STS score for
complex procedures and to be
considered for the same.

8. TAVI2-SCORe
Parameter HR Value
Old Age 1.68 1
Male sex 1.81 1
Recent MI 3.78 2
Anemia 2.03 1
LV dysfunction 1.98 1
Critical aortic stenosis 2.46 1
Renal dysfunction 1.76 1
Porcelain Thoracic
aorta
2.56 1
0,1 2.6 Survival rate
is 88% at 1
year
2 3.6
3 10.5 54%
>4 17.6
Am J Cardiol 2015 Jan 15;115(2):234-42. Epub 2014 Oct 29.
Cannot be generalised
Cannot be applicable to low risk patients with low comorbidities

9. TRIALEVIDENCE

11. PARTNER 1A PARTNER 1B
Results: TAVR was superior to Medical management in inoperable patients,
TAVR was non inferior to SAVR in High risk patients.Consistent at 5 years also.

14. PARTNER 2A Conclusion: TAVR using SAPIEN XT and SAVR were similar
(non inferior) for primary end point at 2 years.Decreased reduction of stroke
and all cause mortality in TF TAVR compared to surgery.
PARTNER II S3 : Propensity score matching showed SAPIEN 3 TAVR is
noninferior to SAVR at 1 year .

31. “This was a very early trial. It started 2 years after CoreValve
was approved in Europe, without any resheathable system,
and also at that time we really didn’t know which patients
needed a pacemaker and which didn’t, so we put more
pacemakers in them than we would for the same conduction
abnormalities today,” Sondergaard commented.
Yet despite the high pacemaker rates and PVL rates, the TAVR and
SAVR patients have the same outcomes, he pointed out. “You can just
imagine how that might be today, with lower pacemaker [implantation]
rates, lower paravalvular leaks, and better procedural outcomes. Ten
years down the line, it’s going to be very interesting to see the current
low-risk studies come out.”

41. Although prognosis remains impaired compared with an age-,
sex-, and origin-matched standardized population, periprocedural
PPM implantation does not seem to affect clinical outcomes
adversely among patients undergoing transfemoral TAVI.
PARTNER 2A trial investIgators

42. CONCLUSIONS: The need for PPI post-TAVR was frequent and associated with an
increased risk of heart failure rehospitalization and lack of LVEF improvement, but not
mortality, after a median follow-up of 4 years. Most patients with new PPI post-TAVR
exhibited some degree of pacing activity at follow-up.
J Am Coll Cardiol Intv 2018;11:301–10

43. G. Tarantini et al. Transcatheter aortic valve implantation in lower-risk patients: what is the
perspective? European Heart Journal (2017) 0, 1–12

48. Conclusions
 NOTION
(82% with STS<4%).
 no differences
 Prosthetic valve opening was larger and mean gradient lower for TAVR
 more mild/moderate prosthetic regurgitation
 New Pacemaker implantation
increased


49. Thank you
‘It was another world’….. ‘suddenly I was travelling all over the world on a
weekly basis to deliver huge training sessions and supervise on-site
proctoring. I was in demand for conferences and workshops as well as for
writing academic papers and articles. It was a very intense and demanding
period. My goal had only been to treat a small number of patients. I
never envisaged that TAVI would take off in the way it has done, and move
towards replacing conventional cardiac surgery so soon’ – Dr.Alain
Cribier after the First TAVR.
French, “ta vie” means “your life”