The PARTNER Cohort A randomized 699 elderly patients, (mean age 84.1), with severe aortic stenosis for TAVI or conventional surgery in 26 centers. The group of patients who received TAVI was divided into two groups: trans-femoral procedure, (244 patients), or trans-apical procedure, (104 patients). After one year mortality was similar but stroke and transient ischemic attacks (TIA) were significantly higher in the TAVI group. In the two-year results, paravalvular aortic regurgitation was the subject of much debate, showing that even mild regurgitation is associated with increased mortality.
After three years, mortality from all causes was nearly identical in the two groups with 44.8% for the surgical group and 44.2% in the TAVI group, (p = 0.483). The stroke rates, which diverged at baseline, were not different after three years, (8.2% in the TAVI group and 9.3% in the surgical group, P = 0.763). The combined end point, (death from any cause or stroke), was 47.1% in the TAVI group and 45.9% in the surgical group, (p = 0.83). Mild, moderate or severe paravalvular aortic regurgitation remained significantly different between the two groups at one, two and three years and for the surgical group, (p <0.001). The mortality of patients with moderate to severe aortic regurgitation was higher than patients with or without regurgitation, (60.8% versus 35.3%, respectively). Even patients with mild impairment had a higher mortality at three years, 44.6%.
Conclusion: After three years, patients with severe symptomatic aortic stenosis at high surgical risk who received conventional surgery or TAVI:
1) There was no difference in all-cause mortality between the two groups.
2) Symptomatic improvement was similar between the two groups and remained throughout the three years.
3) At three-year-old stroke was similar between the two groups, although there were a greater number of periprocedural events in the TAVI group.
4) The gradient and the valve area were similar between the two groups.
5) Even mild paravalvular aortic regurgitation was associated with increased mortality.
Vinod Thourani
2013-03-11
Original title: Three-Year Outcomes after Transcatheter or Surgical Aortic Valve Replacement in High-Risk Patients with Severe Aortic Stenosis.
