From the Guidelines
No, having a Transcatheter Aortic Valve Replacement (TAVR) procedure is not considered an atherosclerotic cardiovascular disease (ASCVD) event. ASCVD events specifically refer to clinical manifestations of atherosclerosis such as myocardial infarction, stroke, transient ischemic attack, or peripheral arterial disease [ 1 ]. TAVR is a procedure performed to treat aortic stenosis, which is typically caused by age-related calcification, congenital abnormalities, or rheumatic heart disease rather than atherosclerosis directly. While patients undergoing TAVR often have risk factors for ASCVD or may have concurrent ASCVD, the procedure itself is a treatment intervention rather than a cardiovascular event.
Key Considerations
- TAVR is recommended for patients with severe symptomatic AS who are unable to undergo surgical AVR due to prohibitive surgical risk and have an expected survival of >1 year after intervention [ 1 ].
- The long-term management of patients after TAVR is similar to that of patients after surgical aortic valve replacement (SAVR), with a focus on periodic monitoring of prosthetic valve function, management of comorbid conditions, and promotion of a healthy lifestyle [ 1 ].
- Patients who have undergone TAVR should still be evaluated for their ASCVD risk based on their medical history, including any previous heart attacks, strokes, or other true ASCVD events.
Implications for Clinical Practice
- The distinction between TAVR as a procedure and ASCVD events is important for risk stratification, medication management decisions, and clinical follow-up protocols.
- Clinicians should consider the individual patient's risk factors, comorbid conditions, and values when making decisions about TAVR and subsequent management [ 1 ].
From the Research
Definition of ASCVD Event
Having a Transcatheter Aortic Valve Replacement (TAVR) is not directly considered an Atherosclerotic Cardiovascular Disease (ASCVD) event.
TAVR Procedure
- TAVR is a treatment for severe, symptomatic aortic stenosis (AS) in patients of all risk categories 2.
- The procedure involves replacing the aortic valve with a transcatheter valve, which is a less invasive alternative to traditional surgical aortic valve replacement (SAVR) 2.
- TAVR outcomes have improved, but remaining challenges include the management of coexistent coronary artery disease, prevention of periprocedural stroke, and issue of durability 2.
Relationship between TAVR and ASCVD
- TAVR is often performed in patients with concomitant coronary artery disease (CAD) and severe aortic stenosis (AS) 3.
- The presence of CAD is a risk factor for ASCVD events, and revascularization of significant lesions is associated with improved clinical outcomes compared to medical therapy 3.
- However, there is no clear evidence that having a TAVR procedure itself is considered an ASCVD event 4, 5, 6.
Management of TAVR Patients
- Patients who undergo TAVR are often managed with antiplatelet therapy, and the use of anticoagulation is considered in certain situations, such as patients with atrial fibrillation or bioprosthetic valve thrombosis 4.
- The optimal antithrombotic strategy for patients with AF who undergo TAVR is not clear, but avoidance of triple therapy by using oral anticoagulation and low-dose aspirin seems to be reasonable 4.