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.
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.
