Do patients with minimally symptomatic severe aortic stenosis benefit from TAVI?

By Dr. Florence Mouy
Edited by Dr. Ahmed El-Medany

A study by Huded et al has assessed the outcomes of transcatheter aortic valve implantation (TAVI) in minimally symptomatic patients.

They performed a retrospective study of 231,285 patients with severe aortic stenosis and normal left ventricular ejection fraction (LVEF) who had undergone TAVI between 2015 and 2021. 20% of these patients were minimally symptomatic prior to TAVI, as defined by a baseline Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) of 75 or over.

The 1-year survival following TAVI was higher in the minimally symptomatic group, compared with patients with moderate to severe symptoms (adjusted HR for death: 0.70 [95% CI: 0.66-0.75]). The odds of being alive and well 1 year following TAVI were also higher in those with minimal symptoms at baseline (OR: 1.19 [95% CI: 1.16-1.23).

Those with minimal symptoms experienced only relatively minor changes in health status scores at 30 days (mean KCCQ-OS increase of 2.7 points [95% CI: 2.6-2.9 points]) and 1 year (mean KCCQ-OS increase of 3.8 points [95% CI: 3.6-4.0 points]), compared with those with worse baseline symptoms (30 day mean KCCQ-OS increase of 32.2 points [95% CI: 32.0-32.3 points]; 1 year mean KCCQ-OS increase of 34.9 points [(95% CI: 34.7-35.0 points]).

These results suggest that patients undergoing TAVI with minimal symptoms at baseline have a higher likelihood of survival at 1 year compared with those with worse symptoms at baseline. This is despite limited improvements in markers of health status scores. Randomised controlled trials are needed to further evaluate whether similar outcomes are reproducible.