While the last 5 years have seen an incredible expansion in the use of transcatheter aortic-vlave replacement (TAVR) for patients with severe aortic stenosis who are not considered suitable for surgery, long-term outcomes data remain scant. The randomised Placement of Aortic Transcatheter Valves (PARTNER) trial found that, as compared with standard therapy, TAVR reduced symptoms and decreased death at one year. Two year follow-up data from the trial have now been published.
Of the 358 patients who underwent randomisation at 21 centres, 43.3% had died at two years, compared to 68.0% in the standard therapy group (p<0.001). The rates of cardiac death were similarly higher in the standard therapy group (31.0% vs 62.4%; p<0.001). Rates of hospitalisation were also higher in the standard therapy group (72.5%) compared to the TAVR group (35.0%; P<0.001). However, the rate of stroke was noted to be higher in the TAVR group, due to more ischaemic events in the first 30 days following the procedure, and thereafter due to the occurrence of more haemorrhagic strokes.
Patients with severe aortic stenosis who are not felt suitable for surgery may benefit from TAVR, which was seen to reduce mortality and hospital admissions. However the mortality benefit may be limited to patients who do not have extensive co-existing conditions, and an increased risk of stroke is seen.
- Makkar RR, Fontana GP, Jilaihawi H et al. Transcatheter Aortic-Valve Replacement for Inoperable Aortic Stenosis. NEJM 2011, published ahead of print. DOI: 10.1056/NEJMoa1202277