Background: Percutaneous aortic valve implantation (TAVI) is the treatment of choice for patients with severe aortic stenosis considered inoperable according to clinical outcomes at 12 months as reported in the PARTNER study, which demonstrated a reduction in mortality and an improvement in the quality of life for patients. However, the long term benefit of this strategy vs. conservative treatment is unknown.
Methods and Results: 358 patients with severe aortic stenosis deemed inoperable were randomized to TAVI or clinical treatment. Total mortality (54.1% versus 80.9%, p <0.0001), cardiac mortality (41.4% versus. 74.5%, p <0.0001) and re-hospitalization (66, 3% versus 93.1%, p <0.0001) at 3 years was lower in the TAVI group. The incidence of stroke was higher in the TAVI group (15.7% versus 5.5%, p = 0.0094), while the combined rate of stroke and death was lower in the TAVI group (80.9% versus 57.5%, p <0.0001). The average gradient post-procedure was 10.2 mmHg and was little changed at 36 months (11.3 mmHg). Valve area post-procedure at 36 months was 1.5 cm2. The presence of severe or moderate leaks was only 2%.
Conclusion: The initial benefit observed with TAVI in inoperable patients was maintained at follow-up after three years at the expense of a reduction in total mortality, cardiac mortality and re-hospitalization. Valve durability was evident in respect to the valve area, medium gradient and proportion of new paravalvular leaks.
Samir Kapadia
2012-10-24
Original title: Three-Year Outcomes of Transcatheter Aortic Valve Replacement(TAVR) in “Inoperable” Patients with Severe Aortic Stenosis: Partner Trial
