PARTNER 2A: Five Year Outcomes of TAVR vs. SAVR in Intermediate-Risk Patients

At five years, intermediate-risk patients with symptomatic severe aortic stenosis (AS) had similar incidences of death from any cause or disabling stroke whether they underwent transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR), based on PARTNER 2A results presented Sept. 28 at TCT 2019. However, researchers noted TAVR using a transthoracic approach had poorer outcomes compared to SAVR.

Researchers randomly assigned 2,032 intermediate-risk patients with severe AS to either TAVR or SAVR at 57 centers. The two-year primary endpoint was all-cause death or disabling stroke in the intention-to -treat population. At five years, all primary and secondary clinical and echo endpoints were analyzed in both intention-to -treat and pre-specified as-treated populations.

Results found event rates at five years for the primary endpoint were 47.9 percent after TAVR and 43.4 percent after SAVR. No difference was observed in the transfemoral cohort over the same time period (44.5 percent TAVR vs. 42.0 percent SAVR). However, in the transthoracic cohort, the rate of death or disabling stroke was significantly higher after TAVR (59.3 percent vs. 48.3 percent). In addition, early improvements in functional status and quality of life were maintained through five years for both TAVR and SAVR patients, researchers said.

"In the longest follow-up for intermediate-risk patients with severe AS, TAVR and SAVR had similar rates of death or disabling stroke," noted Vinod H. Thourani, MD, FACC, chair of the Department of Cardiac Surgery at Medstar Heart and Vascular Institute. "Therefore, TAVR should be considered as an alternative to surgery in intermediate-risk patients with severe AS. However, in patients without acceptable transfemoral access, surgery may be the preferred alternative."

Keywords: TCT19, Transcatheter Cardiovascular Therapeutics, Aortic Valve, Aortic Valve Stenosis, Percutaneous Coronary Intervention, Angiography, Heart Valve Prosthesis

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