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Comprehensive analysis of mortality among patients undergoing TAVR: results of the PARTNER trial.

Abstract：

BACKGROUND:Patients with severe aortic stenosis (AS) who were deemed too high risk or inoperable for conventional aortic valve replacement (AVR) in the PARTNER (Placement of Aortic Transcatheter Valves) trial were randomized to transcatheter aortic valve replacement (TAVR) versus AVR (PARTNER-A arm) or standard therapy (PARTNER-B arm). OBJECTIVES:This study compared when and how deaths occurred after TAVR versus surgical AVR or standard therapy. METHODS:The PARTNER-A arm included 244 transfemoral (TF) and 104 transapical (TA) TAVR patients, and 351 AVR patients; the PARTNER-B arm included 179 TF-TAVR patients and 179 standard therapy patients. Deaths were categorized as cardiovascular, noncardiovascular, or uncategorizable, and were characterized by multiphase hazard modelling. RESULTS:In the PARTNER-A arm, the risk of death peaked after randomization in the TA-TAVR and AVR groups, falling to low levels commensurate with the U.S. population within 3 months. Early risk was less in TF-TAVR patients, resulting in initial superior survival; between 12 and 18 months, risk increased, such that within 2 years, TF-TAVR and AVR patients had similar survival rates. Cardiovascular, noncardiovascular, and uncategorizable deaths for TF-TAVR were 37%, 43%, and 20%, respectively, versus 22%, 41%, and 37%, respectively, for TA-TAVR and 33%, 43%, and 24%, respectively, for AVR. In the PARTNER-B arm, risk with standard therapy was 60% per year; TF-TAVR reduced risk to 20% per year, resulting in 0.5 years of life added within 2.5 years. CONCLUSIONS:In inoperable AS patients, TAVR substantially reduced the risk of cardiovascular death. In high-risk patients, TA-TAVR and AVR were associated with elevated peri-procedural risk more than with TF-TAVR, although cardiovascular death was higher after TF-TAVR. Therefore, TF-TAVR should be considered the standard of care for severely symptomatic inoperable patients or those at high risk of noncardiovascular mortality after conventional surgery. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Svensson LG,Blackstone EH,Rajeswaran J,Brozzi N,Leon MB,Smith CR,Mack M,Miller DC,Moses JW,Tuzcu EM,Webb JG,Kapadia S,Fontana GP,Makkar RR,Brown DL,Block PC,Guyton RA,Thourani VH,Pichard AD,Bavaria JE,Herrmann HC

doi

10.1016/j.jacc.2013.08.1666

subject

Has Abstract

pub_date

2014-07-15 00:00:00

pages

158-68

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(14)02438-3

journal_volume

pub_type

杂志文章,多中心研究,随机对照试验

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Comprehensive analysis of mortality among patients undergoing TAVR: results of the PARTNER trial.