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TAVR benefits elderly but costs questioned

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Australian registry data confirms transcatheter aortic valve replacement (TAVR) effectively reduces mortality in inoperable very elderly patients, however experts are divided over the cost/survival benefit.

Associate Professor Darren Walters, director of cardiology at the Prince Charles Hospital in Brisbane, presented results from the Edwards Sapien Source Registry at the CSANZ 2011 59th Annual Scientific Meeting in Perth on Sunday.

The multicentre trial showed TAVR was safe and effective via transapical (TA) or transfemoral (TF) route in 130 elderly patients with severe aortic stenosis at high risk for surgery. 

After 30 days, patients (average age 84) receiving TAVR via TF had a mortality rate of 5.9% compared with 9.5% in patients (average age 82) undergoing TAVF through TA. 

Stroke rates were 3.0% with TF versus 4.8% with TA, and 1.5% required a pacemaker after surgery with TF compared with 7.9% with TA. 

Acute procedural success rates were “quite acceptable,” with 92.5% via TF and 87.3% cent via TA.

Professor Derek Chew, director of cardiology at Flinders Medical Centre, said while TAVR clearly benefited these patients, there were high procedural costs and patient selection would be a major challenge.

“If you look at the registry, the 85 year olds are getting the valves, but the average life expectancy of an 85 year old in Australia is four years,” he said. 

“So how much life are we actually going to return with this very expensive therapy?” he asked.     

Professor Ian Meredith, director of the Monash Heart Centre in Melbourne, disagreed, saying patients aged 80 to 84 had an average life expectancy of 6.8 years.

“In appropriately selected patients we should be trying to give them six or more years,” he said.

He described the cost-effectiveness data on TAVR as “positive” despite the high price, estimating the cost of transcatheter heart valves at $25,000 compared with $8,000 to 10,000 for surgical valves.

 

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