The 2-year outcomes in patients with severe aortic stenosis and low surgical risk continue to show a numerical benefit in favor of transcatheter aortic valve replacement (TAVR) vs. surgical replacement (CABG) for the primary end point of death, stroke or repeat hospitalization for cardiovascular reasons. However, the initially higher advantage of TAVR has been narrowing down because of an uptick in deaths and strokes. 

When the PARTNER 3 was presented just one year ago for the same ACC event, the difference between these treatments was 7.1%, which was enough to show not just non-inferiority of TAVR vs. CABG, but also superiority. After the virtual presentation of the PARTNER 3 2-year outcomes at the virtual ACC 2020, we observe the difference between both treatments has shrunk to 5.9%, which is still enough to show non-inferiority.

Whether the curves will keep separate, even by a small margin, or not, they continue to follow this trend and end up crossing at some point, this is mere speculation, according to M. Mack himself, who presented the outcomes. 

The PARTNER 3 included 1000 patients with an STS of 4% or lower (mean STS 1.9%) treated with the balloon expandable Sapien 3 or CABG in 71 different centers. 

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At 2 years, TAVR maintains its difference compared against CABG for the combined end point (11.5% vs 17.4%; HR 0.63, 0.45 to 0.88) but not for the individual components (except for repeat hospitalizations).

The main reason behind rehospitalizations in both groups was cardiac failure.

The TAVR group presented a lower incidence of atrial fibrillation (7.9% vs 41.8%) and more new left bundle branch block (24.4% vs 9.4%; p<0.001). Valve thrombosis (VARC 2 definition) was more frequent in the TAVR group (2.6% vs 0.7%; p=0.02).

The echo test at 2 years did not show changes in mean gradient compared to prior levels (13.6 vs 11.8 mmHg; p<0.001), valve area (1.7 vs 1.7 cm2; p=0.69) or paravalvular regurgitation (p<0.001). 

Original Title: Two-year clinical and echocardiographic outcomes from the PARTNER 3 low-risk randomized trial.

Reference: Mack MJ et al. Presentado en forma virtual en el ACC 2020.

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