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Two-Year Outcomes After Transcatheter or Surgical Aortic-Valve Replacement
Study Questions:
What is the relative safety and efficacy of transcatheter or surgical aortic valve replacement at 2 years?
Methods:
The authors reported the 2-year results of the PARTNER trial. This trial randomized 699 high-risk patients with severe aortic stenosis to surgical aortic valve replacement (surgical AVR) or transcatheter aortic valve replacement (TAVR).
Results:
There was no difference in 2-year mortality (33.9% with TAVR vs. 35% with surgery; hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.90-1.15; p = 0.41) or frequency of stroke (HR, 1.22; 95% CI, 0.67-1.22; p = 0.52). Endocarditis was uncommon (1.5% vs. 1%) and improvement in valve area was maintained at 2 years in both arms. Paravalvular regurgitation was more common with TAVR and was an independent predictor of death on follow-up.
Conclusions:
The authors concluded that there was no difference in the 2-year outcome of patients treated with TAVR or surgery for aortic stenosis.
Perspective:
TAVR is one of the most important advances in treatment of valve disease, and this study demonstrates the durability of the results of this technique. Aortic regurgitation was more commonly seen with TAVR and was associated with an increased risk of death. The results of this study reflect early experience with the first-generation device, and it is likely that ongoing refinement in technique and newer generation devices will be associated with further improvement in procedural results and long-term outcomes.
Keywords: Heart Valve Prosthesis, Stroke, Endocarditis, Confidence Intervals
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