Dear Cardiology,
What happened to us?
You were everything to me.
The yin to my yang. The lub to my dub. The suture to my scalpel.
After all these years, this is how you betray me?
You’d hear the murmur I’d miss.
You’d manage the breathless, the dizzy, the pre-syncopal.
You’d hold their hand when I couldn’t even hold eye contact.
But treating them? That's my territory
It was my time to shine. Surgery is supposed to be my thing. I’d open up that chest, replace that valve. I would get the flowers. I would get the glory. 🤬
But I guess going unsung isn’t really your thing, huh?
You’ve replaced my CABG with your angioplasty and stents.
You’ve robbed me of closing septal defects.
Now, you want to take my valve replacements, too?
Yes! I saw that trial you and your cardiac cronies published in .
You wanted to prove that your not-so-surgical transcatheter aortic-valve replacement(TAVR) was just as good as my open-heart valve replacement.
You recruited 1000 patients with severe symptomatic aortic stenosis and low surgical risk. Then randomised them, 1:1, to either receive tranfemoral TAVR or surgery.
You followed them over 7 years to measure a composite of death, stroke, or rehospitalisation related to the procedure, the valve, or heart failure.
And you found… no significant difference 🥀
The primary endpoint occurred in 34.6% of TAVR patients vs 37.2% of surgery patients (−2.6%; HR 0.87; 95% CI 0.70–1.08) at 7 years
Individually:
Deaths: TAVR 19.5% vs Surgery 16.8%
Strokes: 8.5% vs 8.1%
Rehospitalisation: 20.6% vs 23.5%
And safety findings:
New-onset Atrial Fibrillation: way less frequent with TAVR (17.7%) than surgery (43.5%).
New Pacemakers and LBBB: more frequent after TAVR, 17.3% vs 12.8%(get in!)
Significant Valve Thrombosis: higher with TAVR 2.8% vs 0.5% (🙏)
I’m sure you're sitting in your office, all smug about the results, But you cherry-picked, didn’t you?
You chose low-risk patients and excluded anyone remotely complex.
You conducted the trial in top-tier centres with pristine outcomes, not in the real world where variability is… let’s say, wider.
And let’s not ignore the follow-up dropouts…patients who vanished, their outcomes lost in the ether. Dead? Alive? We’ll never know.
Look. I know the above limitation is damning, but I think we can make up. Just go back to being medical, and I can go back to being surgical.
Pretty please.
You're actually scaring me now.
Stay in your lane.
Yours truly,
Cardiothoracic Surgery
