March 2026 | Issue 80
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9 Gene therapy
Innovation holds promise for coronary graft failure
10 Coronary obstruction
First-in-man VECTOR procedure
12 Profile Roxana Mehran
STS 2026
PREVENTION
Evolocumab cuts MACE risk, even in patients with no prior events
Robert Hawkins
STS data suggest surgeons have begun to shift the tide in TAVI explant mortality Operative mortality for surgical aortic valve replacement (SAVR) procedures performed after prior transcatheter aortic valve implantation (TAVI) has improved “dramatically” over the last decade, as surgeons deal with an exponential increase in the volume of TAVI explant cases.
T
his is one finding of an analysis drawing on data from the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database characterising risk over time, used to validate a dedicated risk model to support decision making for patients requiring surgery after TAVI. Results of the analysis, where investigators examined outcomes from more than 5,700 patients who underwent SAVR after TAVI at nearly 700 US centres between 2014 and 2025, were presented as a late-breaking study at the 2026 STS annual meeting (29–31 January, New Orleans, USA). The analysis straddles a period that has seen a rapid expansion in TAVI, during which time transcatheter procedures have overtaken surgery as the predominant approach for the treatment of aortic valve replacement in the USA. TAVI
15 ALIGN-AR
Latest data on Trilogy valve for AR
procedures also now make up close to half of all aortic valve replacements for patients under the age of 65 years. Growth in TAVI has given rise to a marked increase in the need for surgical explant and replacement of failing TAVI valves—with a 12-fold increase in such procedures seen over the 12 years studied. These are often required alongside concomitant procedures, such as mitral valve repair or coronary artery bypass graft (CABG) surgery, which adds to the complexity of the repair. Some early series have reported operative mortality rates as high as 18% for isolated SAVR after TAVI alone; however, the latest analysis suggests that the odds of mortality associated with the procedure have decreased over time. “We can see that patient related factors have declined over time as lower risk and younger patients undergo TAVI. However, outside of this, surgeons appear to be improving their technique as risk of mortality has decreased 3% every year over and above patient-related factors,” presenting author Robert Hawkins (University of Michigan Health, Ann Arbor, USA) tells Cardiovascular News following his presentation at STS 2026. Among the 5,708 cases included in the analysis, 40% involved isolated SAVR after TAVI, with 60% including concomitant procedures such as aortic root enlargement, mitral
Surgeons appear to be improving their technique as risk of mortality has decreased 3% every year.” Robert Hawkins
USE OF THE PCSK9 INHIBITOR evolocumab on a background of high-intensity cholesterollowering regimen has been shown to reduce the risk of major adverse cardiovascular events (MACE) in patients at high cardiovascular risk but who have no history of myocardial infarction (MI) or stroke. This is the headline finding from the VESALIUS-CV trial, a randomised, double-blind trial involving more than 12,000 patients with atherosclerotic cardiovascular disease (ASCVD) or high-risk diabetes who were randomly assigned to receive the drug—which goes by the brand name Repatha (Amgen)—or a placebo. Investigators followed the patients out to a median of 4.6 years and found that patients who received evolocumab had a 25% reduction in the risk of coronary heart disease death, MI, or ischaemic stroke and a 19% reduction in the aforementioned composite or ischaemia-driven arterial revascularisation. Results of the phase 3 trial, which was sponsored by Amgen and conducted by the Thrombolysis In Myocardial Infarction (TIMI) Study Group, were presented during a late-breaking trials session at the American Heart Association (AHA) 2025 scientific sessions (7–10 November, New Orleans, USA) and simultaneously published in the New England Journal of Medicine. A previous TIMI trial— FOURIER—had demonstrated that evolocumab reduced the risk of MACE in patients with established atherosclerotic disease who had a history of major cardiovascular events such as MI or stroke. “We know that lowering LDL with PCSK9 inhibitors, including evolocumab, has been shown to reduce the risk of cardiovascular events in patients with a prior major ASCVD event, such as MI or stroke,” presenting author Erin Continued on page 4
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