TAVR better than SAVR after mediastinal radiation for valve replacement: JACC

USA: TAVR has benefits over SAVR in patients who require valve replacement after undergoing mediastinal radiation, suggests a recent study in the journal JACC: Cardiovascular Interventions.

Mediastinal radiation is used for the treatment of different types of malignancies involving the lungs, chest, breast, lymph nodes and mediastinum. However, the therapy might lead to the development of radiation-associated cardiopulmonary disease, aortic stenosis being most common. Exposure to prior radiation in patients with severe aortic stenosis increases risk of long-term mortality following surgical replacement. Transcatheter aortic valve replacement (TAVR) is a reasonable therapeutic strategy for patients with severe aortic stenosis irrespective of their surgical risk. Percutaneous approach makes a better alternative for the treatment of patients with prior mediastinal radiation undergoing surgical replacement having .high peri-operative mortality and morbidity   

There is a lack of data comparing outcomes of SAVR versus TAVR in patients with prior mediastinal radiation. To address this knowledge gap, Hani Jneid, Baylor School of Medicine, Houston, Texas, and colleagues evaluated the trends and outcomes of patients with prior mediastinal radiation receiving AVR using a large national administrative claims database.

For the purpose, the researchers queried the National Inpatient Sample database years 2012 to 2017 for hospitalization of patients with prior mediasinal radiation who underwent isolated AVER. The study compared the outcomes of TAVR versus SAVR using multivariable analysis. The main study outcome was in-hospital mortality.