Transcatheter Aortic-Valve Replacement for Inoperable Severe Aortic Stenosis

Study Questions:

What is the 2-year outcome of patients who are not candidates for surgery and are treated with transcatheter aortic valve replacement (TAVR)?

Methods:

The authors reported the 2-year results of the PARTNER trial. In this trial, patients with severe symptomatic aortic stenosis who were considered to be at extreme risk for surgical complications were randomized to transfemoral TAVR or to standard therapy.

Results:

A total of 358 patients underwent randomization at 21 centers. There was a significant reduction in the 2-year mortality (43.3% vs. 68.0%, p < 0.001) and cardiac mortality (31% vs. 62%, p < 0.001) with TAVR. The rate of stroke was significantly higher after TAVR (13.8% vs. 5.5%, p = 0.01). This included an increased risk of ischemic events in the first 30 days (6.7% vs. 1.7%, p = 0.02) and more hemorrhagic strokes beyond 30 days in the TAVR group (2.2% vs. 0.6%, p = 0.16). TAVR was associated with a significant reduction in risk of rehospitalization at 2 years (32% vs. 72.5%). The benefit of TAVR was attenuated in patients with extensive comorbidities, and there was no advantage of TAVR in patients with a Society of Thoracic Surgeons (STS) score ≥15.

Conclusions:

TAVR is associated with an impressive reduction in death and need for rehospitalization in patients with inoperable aortic stenosis.

Perspective:

TAVR is one of the most important advances in cardiology in recent years. This study reconfirms the clinical efficacy of the procedure and establishes it as an important therapy for elderly patients with severe aortic stenosis.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery

Keywords: Heart Valve Prosthesis, Stroke, Intracranial Hemorrhages, Comorbidity, Angioplasty


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