Medtronic has announced the expanded FDA approval of the self-expanding CoreValve Evolut transcatheter aortic valve replacement (TAVR) platform to include patients with symptomatic severe aortic stenosis who are at an intermediate risk for open-heart surgery. With hemodynamic performance (a measure of blood flow efficiency) shown to be superior to surgical aortic valve replacement (SAVR), the CoreValve Evolut platform is designed to deliver excellent valve performance for these patients who are often considered to be more active than high- or extreme-risk patients previously indicated for the procedure.
Patients who are at intermediate risk for open-heart surgery have a risk of mortality of >= 3 percent at 30 days following the procedure. The risk assessment is determined by a heart team (including an interventional cardiologist and cardiac surgeon), in combination with the Society of Thoracic Surgeons (STS) score and other factors, such as co-morbidities, frailty, prior surgical intervention, and disabilities.
“As evidenced by the landmark SURTAVI trial, the CoreValve Evolut platform is well-suited for the intermediate-risk patient population due to its supra-annular design for unsurpassed hemodynamics, low rates of mortality and disabling stroke, earlier improvement in quality of life, fast functional recovery times and short hospital stays,” says Michael Reardon, MD, professor of cardiothoracic surgery and Allison Family Distinguished Chair of Cardiovascular Research at Houston Methodist DeBakey Heart & Vascular Center. “It’s important to consider that in the first 30 days, patients treated with TAVR showed functional improvements and lower rates of stroke than the surgical patients in the study.”
The CoreValve Evolut R. (Image credit: Medtronic)
Recently unveiled at the 2017 American College of Cardiology meeting, the global SURTAVI trial evaluated intermediate-risk patients and compared 863 TAVR patients treated with the CoreValve and Evolut R Systems (STS: 4.4 percent) to 794 surgical patients (STS: 4.5 percent). Against the strongest surgical performance (compared to predicted surgical risk of mortality) seen to date in a randomized trial, the CoreValve Evolut platform met its primary endpoint of non-inferiority compared to surgery in all-cause mortality or disabling stroke (12.6 percent for TAVR versus 14.0 percent for SAVR; posterior probability of non-inferiority >0.999). The CoreValve Evolut platform also demonstrated significantly better mean aortic valve gradients (7.8 mm Hg vs. 11.8 mm Hg; p<0.001) at two years. SAVR was associated with less aortic regurgitation, major vascular complications and need for permanent pacemaker implantation.
“Patients at intermediate risk for open-heart surgery account for a large portion of the severe aortic stenosis population,” says Rhonda Robb, vice president and general manager of the Heart Valve Therapies business, a part of Medtronic’s Cardiac and Vascular Group. “We are delighted to take the self-expanding CoreValve Evolut platform to more patients with aortic stenosis who can benefit from this therapy.”
The CoreValve Evolut platform consists of the CoreValve, CoreValve Evolut R, and the recently FDA-approved CoreValve Evolut PRO systems, which are available for use in the United States with severe aortic stenosis patients at an intermediate surgical risk or greater. The CoreValve Evolut PRO System is currently not approved for commercial use outside of the United States.
