SURTAVI: Should TAVI become class I for intermediate-risk patients with severe aortic stenosis?

ACC.17 Late breaking clinical trial:  Transcatheter Aortic Valve Replacement with a self-expanding bioprothesis compared with surgical aortic valve replacement in patients at intermediate surgical risk: first results from the SURTAVI clinical trial Michael REARDON, Houston

Reported from the American College of Cardiology 2017 Scientific Sessions in Washington.

Overall, the second highly anticipated trial of the day did not disappoint the interventional community.

A few days ago, an update of the American guidelines for valvular heart disease has issued a class IIa recommendation for patients with aortic stenosis undergoing TAVI (as an alternative to surgery) and deemed at intermediate surgical risk. European guidelines are expected later this year.

SURTAVI consistent with hypothesis of TAVI with self-expanding prosthesis noninferior to surgery

SURTAVI was consistent with the hypothesis of TAVI with a self-expanding prosthesis being noninferior to surgery, although the pattern of complications was different between the two procedures (i.e., more pacemaker implantation and paravalvular leakage in the TAVI arm, significantly more acute kidney injury, atrial fibrillation, transfusions and numerically more strokes in the surgical arm).

These results has led to some arguing provocatively that the American class IIa recommendation has become already obsolete in a few days, warranting an upgrade to class I.

Others observe that the class IIa is justified even after SURTAVI in the absence of long-term durability data to dispel current concerns over expanding the TAVI option to lower-risk patients.

 

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