Interventional choice for the aortic stenosis patient (SAVR, TAVR, or BAV)

Interventional choice for the Aortic Stenosis Patient: SAVR, TAVR, or BAV Peter M... Natural History of Aortic Stenosis... Natural History of Aortic Stenosis... 30% of Patients with Se

Interventional choice for the Aortic

Stenosis Patient: SAVR, TAVR, or

BAV

Peter M Pollak MD

Outline

Natural History of Aortic Stenosis

Natural History of Aortic Stenosis

30% of Patients with Severe Symptomatic AS are “Untreated”!

Charlson 2006

Bach 2009

Spokane (prelim)

Vannan (Pub.

Pending)

Severe Symptomatic Aortic Stenosis

Percent of Cardiology Patients Treated

AVR

No AVR

Under-treatment especially prevalent among patients managed

by Primary Care physicians

Reasons for non-treatment:

1 elderly

2 co-morbidities

3 patient refusal

TAVR vs Med Tx for Inoperable Patients

Cardiovascular Mortality - ITT

All-Cause Mortality or Strokes (ITT)

HR [95% CI] = 0.98 [0.79, 1.21]

Different Patient Populations?

Intermediate risk trials ongoing…

WHICH TAVR VALVE?

Failure Driven by:

(1) Incorrect Positioning – 1 vs 7

(2) Mod/Severe Prosthetic Regurgitation – 5 vs 22

Valve Function is Similar

BALLOON VALVULOPLASTY

Resurgence of interest in BAV

EuroIntervention 2013;8:1388-1397

Survival in BAV as Bridge

Conclusions:

Which approach for whom?

Low and Intermediate Risk patients

superiority of TAVR

Thank you!

Pollak.peter@mayo.edu