Editorial
2020 Apr 6;S0828-282X(20)30316-0.
JOURNAL：Can J Cardiol.
Article Link
Precision Medicine in TAVR: How to Select the Right Device for the Right Patient
G Marquis-Gravel, S Vemulapalli, AW Asgar et al.
KEYWORDS
patient selection; TAVR
Transcatheter aortic valve replacement (TAVR) represents a first-line option for the
treatment of patients with severe symptomatic aortic stenosis across the entire spectrum
of surgical risks. Given the expected growth of TAVR procedures in low-risk patients,
many factors other than the primary endpoints of pivotal TAVR trials (either death,
or the composite of death or stroke) need to be considered during the selection of
a treatment strategy. Such factors include the risk of procedural complications (permanent
pacemaker implantation, stroke, new-onset atrial fibrillation, vascular complications,
etc), device hemodynamic performance and durability (paravalvular leak [PVL], reinterventions),
indication for antithrombotic therapy, and patient quality of life. The pivotal TAVR
trials have indicated that some complications with TAVR vs surgical aortic valve replacement
(SAVR) vary according to the device under study. For example, rates of permanent pacemaker
implantation were higher with TAVR vs SAVR in trials evaluating self-expanding valves,
but not in the those evaluating balloon-expandable valves. TAVR represents a suitable option for all risk groups, but how do we personalise
care and select the most appropriate device for our patients?
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