This study included 358 patients considered inoperable, randomized to TAVR with expandable balloon valve versus conservative treatment. The 5-year end points included all-cause mortality, cardiac mortality, re-hospitalization, and stroke. At 5 years, mortality from all causes was lower in TAVR group versus conservative treatment group (71.8% versus 93.6%, P <0.0001). By dividing patients by STS score, all subgroups benefited valve replacement (STS 15 57.8% versus 91.8%). Correspondingly, re-hospitalization rate was higher in the conservative strategy (87.3% versus 47.6%, P <0.0001). The incidence of stroke was 14.6% in the TAVR group and 5.7% in the conservative group. Moderate to severe paravalvular insufficiency was associated with increased cardiovascular mortality, particularly in patients with less comorbidity.
Conclusion
A 5-year the benefit of transcatheter aortic valve replacement remained on inoperable patients with severe aortic stenosis, in terms of total mortality, cardiovascular mortality, hospitalizations and improvement in functional class.
3_samir_kapadia
Samir R. Kapadia
2014-09-14
Original title: Five-Year Results From a Prospective, Randomized Trial of Transcatheter Aortic Valve Replacement with a Balloon-Expandable Device Versus Conservative Care in Extremely High-Risk Patients with Aortic Stenosis.
