Effect of Valve Type and Anesthesia Strategy for TAVR: 5-Year Results of the SOLVE-TAVI Trial (JACC January 2025-1)-Article: Effect of Valve Type and Anesthesia Strategy for TAVR: 5-Year Results of the SOLVE-TAVI Trial

Article: Effect of Valve Type and Anesthesia Strategy for TAVR: 5-Year Results of the SOLVE-TAVI Trial

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The SOLVE-TAVI trial, a randomized study, investigated the long-term effects of valve type and anesthesia strategy in patients undergoing transcatheter aortic valve replacement (TAVR), with observations extending over 5 years. The trial focused on comparing two types of valves: self-expanding valves (SEV; Evolut R) versus balloon-expandable valves (BEV; SAPIEN 3), and two anesthesia strategies: general anesthesia (GA) versus conscious sedation (CS).<br /><br />Participants in the study were 447 intermediate- to high-risk patients with severe, symptomatic aortic stenosis. The trial followed a 2x2 factorial design at multiple centers, ensuring results were comprehensive. Key findings include that both valve types and anesthesia strategies yielded similar outcomes at the 5-year mark concerning the primary composite endpoint of all-cause mortality, stroke, moderate or severe paravalvular leakage, and permanent pacemaker implantation.<br /><br />Notably, stroke rates were lower in the SEV group (2.2%) compared to the BEV group (9.6%). In terms of anesthesia, the CS group experienced a lower rate of all-cause mortality (41.5%) compared to the GA group (54.3%). Despite these differences, the combined endpoint did not show significant variances between the different groups.<br /><br />The trial's outcomes highlight that while specific advantages were observed with SEV in stroke reduction and with CS in lowering mortality, overall, both valve and anesthesia strategies were effective. These observations suggest that for intermediate to high-risk patients undergoing TAVR, the selection of valve type and anesthesia method may be based on other factors rather than long-term clinical outcomes, given their general equivalence in effectiveness over a 5-year period.

Keywords

SOLVE-TAVI trial

transcatheter aortic valve replacement

TAVR

self-expanding valves

balloon-expandable valves

general anesthesia

conscious sedation

aortic stenosis

stroke reduction

mortality rates