Best evidence topic: implante valvular aórtico transcatéter en pacientes con estenosis aórtica grave asintomática

Background

Transcatheter aortic valve implantation (TAVI) has become the most frequent option for severe aortic stenosis treatment. Patients with severe aortic stenosis may present an increased risk of mortality in the asymptomatic phase. Furthermore, the progression of their heart disease may have prognostic implications. It is proposed to carry out a bibliographic review to assess the benefit of TAVI in this context.

Methods

A systematic search in Pubmed and Cochrane was conducted, identifying comparative studies on surgery and/or TAVI versus conservative management in asymptomatic patients. Thus, an algorithm of better management of patients with severe aortic stenosis would be developed according to the available evidence.

Results

After the selection of papers and elimination of duplicates, 34 studies were full-text analyzed, among which we remark: 6 meta-analyses, 4 reviews, 14 original articles and 4 ongoing clinical trials were identified. Early surgery was unanimously superior to conservative management in terms of survival. In the case of TAVI, two studies demonstrated a better prognosis for asymptomatic patients compared to symptomatic patients when their valve disease was corrected with TAVI, and a sub-analysis of the Evolut Low Risk trial demonstrated superior survival results for TAVI compared to surgery and conservative treatment.

Conclusions

In the absence of a solid evidence, TAVI can be considered a valid treatment alternative for patients with asymptomatic aortic stenosis, although this indication relies on indirect evidence. More research is needed in this field.