TAVR vs. Surgery: Valve Performance at Five Years (PARTNER I)

The aim of this study was to evaluate the long-term performance of transcatheter aortic valve replacement (TAVR) and surgically-implanted valves through longitudinal echocardiographic follow-up of the PARTNER I trial patients.

The study included all patients receiving TAVR or undergoing surgery who had a post-implant echocardiogram at five years analyzed for peak systolic velocity, mean gradient, valve area, outflow tract, in-stent velocities, Doppler velocity index, degree of aortic regurgitation, ventricular mass index, stroke volume index, and cardiac index.

Post-implant echocardiograms were compared with echocardiograms at five years in 86 patients who underwent TAVR and 48 patients who underwent conventional surgery. Baseline characteristics were very similar between both groups.

In patients who underwent TAVR, the valve area did not change significantly in five years (p = 0.35). The mean gradient also remained stable (11.5 ± 5.4 mm Hg after implant and 11.0 ± 6.3 mm Hg at five years; p = 0.41).

In contrast, the peak valve and outflow tract velocities decreased significantly over time (p = 0.03 and p = 0.008, respectively).

There was no change in total aortic insufficiency (p = 0.40), paravalvular insufficiency (p = 0.26), or transvalvular insufficiency (p = 0.37). The stroke volume index and the cardiac index remained stable. There was a significant regression of the left ventricular mass index (p <0.001).

The longitudinal evaluation among patients who underwent conventional surgery revealed similar trends.

In both patient groups, patients alive at five years presented a low rate of adverse events at follow-up.

Conclusion

Longitudinal echocardiographic follow-up of the PARTNER (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial) I trial showed that valve performance in both cases (TAVR and conventional surgery) is stable at 5 years.

Original title: Long-Term Valve Performance of TAVR and SAVR. A Report from the PARTNER I Trial.

Reference: Melissa A. Daubert et al. J Am Coll Cardiol Img 2017;10:15-25.

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