This is a one minute journal club-ish. This is not medical advice. Read the article for yourself and do not trust me.
Patients with severe, symptomatic aortic stenosis: what’s the best way to fix it, surgical AVR or a TAVR.
TAVR and TAVI are the same thing.
This is a non-inferiority trail meaning they didn’t think there would be a difference.
They recruited over 900 pts to find out.
Great job to the authors. Hat tip to them.
Median age of 81.
Baseline characteristics look good to me.
Primary outcome was all cause mortality at 1 year.
As much as the pretty Kaplan Meier curve looks like there’s a difference in all-cause mortality, there is no difference.
The best part of the paper is in the supplemental paper.
Here, the authors performed a subgroup analysis to see if they could tease a benefit in a particular group.
Nothing worth writing home about, though.
Table 4 looks at total length of stay. Here’s where it gets important. After all, most things come down to money.
TAVR patients stayed for a median of 3 days vs. 8 for the surgical AVR.
TAVR’s also leave me unemployed as 75.3% of them do not need an ICU bed vs. the AVR where 95% need an ICU bed.
It’s okay, though, because I could find other things to do with my time.
The next question is which valve, TAVR or surgical AVR, lasts longer?
CLICK HERE for my CVICU Post-op Post.
Citation for TAVR vs. AVR
UK TAVI Trial Investigators, Toff WD, Hildick-Smith D, Kovac J, Mullen MJ, Wendler O, Mansouri A, Rombach I, Abrams KR, Conroy SP, Flather MD, Gray AM, MacCarthy P, Monaghan MJ, Prendergast B, Ray S, Young CP, Crossman DC, Cleland JGF, de Belder MA, Ludman PF, Jones S, Densem CG, Tsui S, Kuduvalli M, Mills JD, Banning AP, Sayeed R, Hasan R, Fraser DGW, Trivedi U, Davies SW, Duncan A, Curzen N, Ohri SK, Malkin CJ, Kaul P, Muir DF, Owens WA, Uren NG, Pessotto R, Kennon S, Awad WI, Khogali SS, Matuszewski M, Edwards RJ, Ramesh BC, Dalby M, Raja SG, Mariscalco G, Lloyd C, Cox ID, Redwood SR, Gunning MG, Ridley PD. Effect of Transcatheter Aortic Valve Implantation (TAVR) vs Surgical Aortic Valve Replacement (AVR) on All-Cause Mortality in Patients With Aortic Stenosis: A Randomized Clinical Trial. JAMA. 2022 May 17;327(19):1875-1887. doi: 10.1001/jama.2022.5776. PMID: 35579641.
Link to Article (NOT FREE)
Consider purchasing my book, ‘The Vasopressor & Inotrope Handbook’!
I have written “The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals,” a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. If you’re in the US, you can order A SIGNED & PERSONALIZED COPY for $29.99 or via AMAZON for $32.99 (for orders in or outside the US).
Ebook versions are available via AMAZON KINDLE for $9.99, APPLE BOOKS, and GOOGLE PLAY.
¡Excelentes noticias! Mi libro ha sido traducido al español y está disponible a traves de AMAZON. Las versiones electrónicas están disponibles para su compra for solo $9.99 en AMAZON KINDLE, APPLE BOOKS y GOOGLE PLAY.
When you use these affiliate links, I earn an additional commission at no extra cost to you, which is a great way to support my work.
Disclaimer
Although great care has been taken to ensure that the information in this post is accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.