Adult Cardiac

On day one of STS 2024, meeting goers attended numerous sessions that explored the growing debate between SAVR and TAVR as treatment options,

"Improved Longitudinal Outcomes with Surgical Aortic Valve Replacement with Atrial Fibrillation Management over Transcatheter Aortic Valve Replacement Alone," part of the larger "Bring SAVR Back" session given by J Hunter Mehaffey, MD, unveiled Class I guideline recommendations that support atrial fibrillation (AF) treatment during surgical aortic valve replacement (SAVR). And how recently, many low to intermediate risk patients with AF and aortic stenosis (AS) are managed by transcatheter aortic valve replacement (TAVR). And finally, they evaluated real-world longitudinal outcomes of TAVR vs SAVR with or without AF treatment. 

"We concluded that in Medicare beneficiaries with AF who required aortic valve replacement, SAVR with concomitant treatment of AF was associated with improved longitudinal survival and freedom from stroke compared to TAVR," noted Dr. Mehaffey. "Consideration should be given for SAVR with AF treatment as a first-line approach for patients with AF requiring aortic valve replacement." 

In his discussion of "Robotic Aortic Valve Replacement versus Transcatheter Aortic Valve Replacement: A Propensity Matched Analysis," Vikrant Jagadeesan, MD, presented findings on contemporary data that supports equipoise between surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR) for the management of symptomatic severe aortic stenosis (AS). He further explained that controversy exists around the optimal management of patients in low to intermediate risk categories, and how the study compared outcomes of surgical robotic aortic valve replacement (RAVR) to TAVR. 

"Compared to TAVR, RAVR was associated with lower stroke and PPM rates, less PVL, and improved 1 year survival," said Dr. Jagadeesan. "And RAVR may provide a safe and effective minimally invasive first-line alternative for low to intermediate risk patients presenting with symptomatic AS."

In a late breaking session titled, "Cardiac Surgery after Transcatheter Aortic Valve Replacement: Trends and Outcomes," Michael Bowdish, MD, illustrated how his research team set out to document trends and outcomes in cardiac surgery following transcatheter aortic valve replacement (TAVR), a topic gaining importance as reports of subsequent cardiac operations and early TAVR explantations increase. Using the Society of Thoracic Surgeons Adult Cardiac Surgery Database, the study covers adult patients who underwent cardiac surgery after an initial TAVR from January 2012 to March 2023. 

"The study findings underscore the escalating need for both aortic and non-aortic valve cardiac surgeries following TAVR," explained Dr. Bowdish. "They note a substantial increase in the frequency of these surgeries, emphasizing the importance of understanding outcomes."  He observed elevated risk in these cases, as indicated by mortality and stroke rates, which calls for careful consideration, particularly given the expanding use of TAVR across a broader range of age and risk profiles. Finally, the study suggests the need for ongoing assessment and longitudinal evidence to inform decision-making in the evolving landscape of TAVR applications. 

This presentation on day one of STS 2024 will report on a comprehensive approach that focuses on maximizing survival and optimizing the utilization of donor hearts in patients with hypoplastic left heart syndrome (HLHS) and HLHS-related malformations with functionally univentricular ductal-dependent systemic circulation. 

“A Comprehensive Approach to the Management of Patients with HLHS and HLHS-Related Malformation” will begin at 9:45 a.m. CT in room Stars at Night 1.  The presentation is part of the STS “Cardiac Center in Evolution: Management of Single Ventricle” session.
  
Dr. Mark Bleiweis, from the University of Florida, will report on findings describing outcomes that resulted from using this approach in 100 consecutive neonates. During the talk, Dr. Bleiweis will detail how these neonates with HLHS and HLHS-related malformations, during an eight-year period, were stratified into three different pathways based on their risk factors, and mortality rates that resulted for these neonates.

“This study is based on the principle that some patients with HLHS or HLHS-related malformations are at very high-risk for Norwood (Stage 1) palliation or hybrid palliation secondary to important cardiac risk factors,” said Dr. Bleiweis.