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Aortic stenosis: Trial examines the best treatment

August 11, 2014

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Sunnybrook has joined an international trial examining the best treatment for patients with severe aortic stenosis, the narrowing of the aortic valve, at intermediate risk of complications from open-heart surgery.

The Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) trial, is in the process of recruiting 2,500 patients and is the largest randomized, multi-site trial on transcatheter aortic valve implementation (TAVI) to date. Patients will receive either a Medtronic CoreValve system or surgical aortic valve replacement and be followed for five years.

“TAVI has already become the ‘gold standard’ therapeutic option for high-surgical risk or inoperable patients with severe symptomatic aortic stenosis. However, there are many more patients who are deemed at intermediate risk for surgery. These patients tend to be younger with fewer comorbidities than the current patients we typically treat with TAVI,” says Dr. Sam Radhakrishnan, interventional cardiologist and Director, Cardiac Catheterization Labs, Sunnybrook. “This trial will provide valuable information as to whether a less invasive option like TAVI is as good an option for this group of intermediate-risk patients, or whether traditional aortic valve replacement is better.”

Sunnybrook is one of five sites in Canada participating in the trial and has already recruited six patients, with the goal of approximately 25 more patients over the next two years. Patients are evaluated by an experienced heart team at Sunnybrook’s Schulich Heart Centre that includes interventional cardiologists and cardiac surgeons.

“I often hear patients asking whether there are less invasive options for aortic stenosis, and it’s our hope that this trial will provide good data for this group,” adds Dr. Stephen Fremes, cardiac surgeon, Sunnybrook, who is co-leading the SURTAVI trial at Sunnybrook with Dr. Radhakrishnan. “Our goal is to provide evidence-based recommendations in the treatment of severe aortic stenosis so that patients receive the most effective treatment."

Sam Radhakrishnan

Full media release

Aortic stenosis treatment for patients at intermediate surgical risk

Sunnybrook has joined an international trial examining the best treatment for patients with severe aortic stenosis, the narrowing of the aortic valve, at intermediate risk of complications from open-heart surgery.

The Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) trial is in the process of recruiting 2,500 patients and is the largest randomized, multi-site trial on transcatheter aortic valve implementation (TAVI) to date. Patients will receive either a Medtronic CoreValve system or surgical aortic valve replacement and be followed for five years.

“TAVI has already become the ‘gold standard’ therapeutic option for high-surgical risk or inoperable patients with severe symptomatic aortic stenosis. However, there are many more patients who are deemed at intermediate risk for surgery. These patients tend to be younger with fewer comorbidities than the current patients we typically treat with TAVI,” says Dr. Sam Radhakrishnan, interventional cardiologist and Director, Cardiac Catheterization Labs, Sunnybrook. “This trial will provide valuable information as to whether a less invasive option like TAVI is as good an option for this group of intermediate-risk patients, or whether traditional aortic valve replacement is better.”

Sunnybrook is one of five sites in Canada participating in the trial and has already recruited six patients, with the goal of approximately 25 more patients over the next two years. Patients are evaluated by an experienced heart team at Sunnybrook’s Schulich Heart Centre that includes interventional cardiologists and cardiac surgeons.

“I often hear patients asking whether there are less invasive options for aortic stenosis, and it’s our hope that this trial will provide good data for this group,” adds Dr. Stephen Fremes, cardiac surgeon, Sunnybrook, who is co-leading the SURTAVI trial at Sunnybrook with Dr. Radhakrishnan. “Our goal is to provide evidence-based recommendations in the treatment of severe aortic stenosis so that patients receive the most effective treatment."

Betty Matthews, an 89-year-old Toronto resident who had TAVI in April 2014 at Sunnybrook, is an example of a patient in the high-risk surgical category who greatly benefited from the procedure. “I’ve been active all of my life but I found myself having shortness of breath and finding it hard to walk up the stairs,” says Betty Matthews. “After having TAVI, I’ve been to weddings, I’m getting out to play bridge with friends and really enjoying keeping busy with my ten grandchildren and four great grandchildren.”

Betty’s son, Dr. Michael Matthews, is a family physician specializing in geriatric care, and remarks that the treatment has had a remarkable impact on his mother’s quality of life. “My mother’s breathing was severely limited by her cardiac issues. It was difficult to see as she is such an active woman and is cognitively fine,” says Dr. Michael Matthews. “It’s phenomenal to see her now after TAVI, she’s traveling around the countryside with her grandchildren.”

Dr. Radhakrishnan notes that throughout the trial there will be a continued emphasis on the role of multidisciplinary heart team in patient selection for TAVI.

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