Comparison of Transcatheter and Surgical Aortic Valve Replacement in Severe Aortic Stenosis

• Published in: Journal of the American College of Cardiology Vol. 61; no. 25; pp. 2514 - 2521
• Main Authors: Hahn, Rebecca T., MD, Pibarot, Philippe, DVM, PhD, Stewart, William J., MD, Weissman, Neil J., MD, Gopalakrishnan, Deepika, MD, Keane, Martin G., MD, Anwaruddin, Saif, MD, Wang, Zuyue, MD, Bilsker, Martin, MD, Lindman, Brian R., MD, Herrmann, Howard C., MD, Kodali, Susheel K., MD, Makkar, Raj, MD, Thourani, Vinod H., MD, Svensson, Lars G., MD, Akin, Jodi J., MS, Anderson, William N., PhD, Leon, Martin B., MD, Douglas, Pamela S., MD
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 25.06.2013; Elsevier Limited
• Subjects: aortic stenosis; Cardiology; Cardiovascular; echocardiography; Internal Medicine; Laboratories; Mortality; Prostheses; Statistical methods; surgical aortic valve replacement; transcatheter aortic valve replacement; Variables; confidence interval(s); echocardiography; RWTp; ITT; HR; LV; LVED; left ventricular diastolic volume; LVSV; TAVR; effective orifice area; relative wall thickness: the septal and posterior wall thickness; aortic stenosis; hazard ratio(s); relative wall thickness: using formula twice the posterior wall thickness; left ventricular end-systolic dimensions; EOA; transcatheter aortic valve replacement; left ventricular; LVES; intention-to-treat analysis; CI; SAVR; RWT; left ventricular end-diastolic dimensions; left ventricular systolic volume; RWTm; transcatheter aortic valve replacement; surgical aortic valve replacement; relative wall thickness; LVDV
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2013.02.087

Objectives This study sought to compare echocardiographic findings in patients with critical aortic stenosis following surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Background The PARTNER (Placement of Aortic Transcatheter Valves) trial randomized patients 1:1 to SAVR or TAVR. Methods Echocardiograms were obtained at baseline, discharge, 30 days, 6 months, 1 year, and 2 years after the procedure and analyzed in a core laboratory. For the analysis of post-implantation variables, the first interpretable study (≤6 months) was used. Results Both groups showed a decrease in aortic valve gradients and increase in effective orifice area (EOA) (p < 0.0001), which remained stable over 2 years. Compared with SAVR, TAVR resulted in larger indexed EOA (p = 0.038), less prosthesis-patient mismatch (p = 0.019), and more total and paravalvular aortic regurgitation (p < 0.0001). Baseline echocardiographic univariate predictors of death were lower peak transaortic gradient in TAVR patients, and low left ventricular diastolic volume, low stroke volume, and greater severity of mitral regurgitation in SAVR patients. Post-implantation echocardiographic univariate predictors of death were: larger left ventricular diastolic volume, left ventricular systolic volume and EOA, decreased ejection fraction, and greater aortic regurgitation in TAVR patients; and smaller left ventricular systolic and diastolic volumes, low stroke volume, smaller EOA, and prosthesis-patient mismatch in SAVR patients. Conclusions Patients randomized to either SAVR or TAVR experience enduring, significant reductions in transaortic gradients and increase in EOA. Compared with SAVR, TAVR patients had higher indexed EOA, lower prosthesis-patient mismatch, and more aortic regurgitation. Univariate predictors of death for the TAVR and SAVR groups differed and might allow future refinement in patient selection. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894 )