{"id":8666,"date":"2011-06-10T12:12:52","date_gmt":"2011-06-10T16:12:52","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=8666"},"modified":"2011-07-19T17:44:13","modified_gmt":"2011-07-19T21:44:13","slug":"tavr-a-stroke-of-genius-or-bad-luck","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/06\/10\/tavr-a-stroke-of-genius-or-bad-luck\/","title":{"rendered":"TAVR: A Stroke of Genius or Bad Luck?"},"content":{"rendered":"

After presentations at the ACC and American Association for Thoracic Surgery 2011 meetings, the PARTNER A results are finally published<\/em><\/strong>.<\/a> PARTNER A compared\u00a0 transaortic valve replacement (TAVR, also known as TAVI) with surgical aortic valve replacement (AVR) in patients with aortic stenosis who were eligible for AVR but considered\u00a0to be at high surgical risk\u00a0.<\/span><\/p>\n

At 1-year follow-up, survival and symptom improvement were similar with the two procedures, but the stroke rate was higher with TAVR\u00a0 (6.0% vs. 3.1%). What do we know about TAVR-associated strokes?<\/em><\/strong><\/span><\/p>\n

    \n
  1. The smaller the valve area, the higher the stroke risk.<\/span><\/li>\n
  2. Patients with \u201cgeneralized heavy arteriosclerotic burden\u201d (i.e., those whose severe PAD renders them ineligible for the transfemoral approach) have a higher stroke risk than those with lighter atherosclerotic burdens; however,<\/strong><\/em><\/span><\/li>\n
  3. Stroke risk was unrelated to atrial fibrillation or TAVR approach (transapical vs. transfemoral).<\/span><\/li>\n
  4. With TAVR, the hazard for stroke was seen early (within 48 hrs of the procedure) and remained elevated throughout the 24 months of follow-up, but AVR-associated strokes occurred early.<\/span><\/li>\n<\/ol>\n

    Based on these data, how would you choose which procedure \u2014 AVR or TAVR \u2014 to recommend for your patients? <\/em><\/strong><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

    After presentations at the ACC and American Association for Thoracic Surgery 2011 meetings, the PARTNER A results are finally published. PARTNER A compared\u00a0 transaortic valve replacement (TAVR, also known as TAVI) with surgical aortic valve replacement (AVR) in patients with aortic stenosis who were eligible for AVR but considered\u00a0to be at high surgical risk\u00a0. At […]<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20,1,9],"tags":[840,396,253,423],"class_list":["post-8666","post","type-post","status-publish","format-standard","hentry","category-cardiac-surgery","category-general","category-interventional-cardiology","tag-avr","tag-partner","tag-stroke","tag-tavi"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/8666","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=8666"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/8666\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=8666"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=8666"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=8666"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}