TAVR vs. Surgical Aortic Valve Replacement (AVR): 1-Minute Journal Club

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)

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