Commentary

The Changing Face of Structural Heart Intervention

In this issue of Cardiology Today’s Intervention, we feature a very timely Cover Story titled “A New Era for TAVR.” Indeed, we are currently entering a new era for structural heart disease in general, including TAVR.

Much of the TAVR discussion has focused on the two trials presented at the American College of Cardiology Scientific Session in March, which have revolutionized the field of TAVR, now demonstrating clear benefits of TAVR vs. surgery in low-risk patients. While there are patient subsets for whom surgery remains the preferred therapy, and while we also certainly need data on longer-term durability for TAVR in younger patients, I imagine that for older patients, regardless of their surgical risk, they will be getting TAVR for symptomatic severe aortic stenosis. Furthermore, I would predict that the durability of the currently available TAVR valves will not be inferior to current surgical bioprostheses. Thus, these data from ACC, with respect to TAVR, really are game-changing.

In terms of other game-changing technologies in structural heart, the recent COAPT trial, with new data presented at ACC, further support the value of percutaneous mitral valve repair in carefully selected patients. A new FDA indication in the COAPT population for the MitraClip (Abbott) will further fuel the enthusiasm about structural heart intervention. Read more in The Take Home: ACC.

Beyond structural heart-related data at ACC, there were several other important trials presented. One that is particularly relevant to interventional cardiology is the AUGUSTUS trial, which showed rather convincingly that double antithrombotic therapy was better than triple antithrombotic therapy in patients with atrial fibrillation needing PCI or with ACS.

Finally, in the Feature, we cover the ongoing controversy regarding paclitaxel-coated devices and whether there really is, or isn’t, a safety issue with use of these devices for peripheral artery disease.

Hopefully, this coverage of important, timely topics is useful to your practice.

In this issue of Cardiology Today’s Intervention, we feature a very timely Cover Story titled “A New Era for TAVR.” Indeed, we are currently entering a new era for structural heart disease in general, including TAVR.

Much of the TAVR discussion has focused on the two trials presented at the American College of Cardiology Scientific Session in March, which have revolutionized the field of TAVR, now demonstrating clear benefits of TAVR vs. surgery in low-risk patients. While there are patient subsets for whom surgery remains the preferred therapy, and while we also certainly need data on longer-term durability for TAVR in younger patients, I imagine that for older patients, regardless of their surgical risk, they will be getting TAVR for symptomatic severe aortic stenosis. Furthermore, I would predict that the durability of the currently available TAVR valves will not be inferior to current surgical bioprostheses. Thus, these data from ACC, with respect to TAVR, really are game-changing.

In terms of other game-changing technologies in structural heart, the recent COAPT trial, with new data presented at ACC, further support the value of percutaneous mitral valve repair in carefully selected patients. A new FDA indication in the COAPT population for the MitraClip (Abbott) will further fuel the enthusiasm about structural heart intervention. Read more in The Take Home: ACC.

Beyond structural heart-related data at ACC, there were several other important trials presented. One that is particularly relevant to interventional cardiology is the AUGUSTUS trial, which showed rather convincingly that double antithrombotic therapy was better than triple antithrombotic therapy in patients with atrial fibrillation needing PCI or with ACS.

Finally, in the Feature, we cover the ongoing controversy regarding paclitaxel-coated devices and whether there really is, or isn’t, a safety issue with use of these devices for peripheral artery disease.

Hopefully, this coverage of important, timely topics is useful to your practice.