The Placement of Aortic Transcatheter Valves (PARTNER) trial demonstrated that transcatheter aortic valve replacement (TAVR) for high-risk patients with aortic stenosis resulted in similar outcomes at 1, 2 and 3 years compared with surgical aortic valve replacement (SAVR). The present study reports the 5-year outcomes of this trial. The study enrolled 699 patients who were randomized to SAVR or TAVR (via a transfemoral or transapical approach). Overall, mean age was 84.1 years, 94% were NYHA Class 3 or 4, and the mean Society of Thoracic Surgeons Predicted Risk of Mortality at 30 days was 11.8%. At 5 years, there were no significant differences in mortality between groups (67.8% in the TAVR group versus 62.4% in the SAVR group; hazard ratio 1.04, 95% CI 0.86–1.24; p=0.76). Additionally, there were no significant differences in cardiovascular mortality, stroke, or need for repeat hospital admission. Patients receiving TAVR experienced more major vascular complications (11.9% vs 4.7%; p=0.0002) and fewer major bleeding events (26.6% vs 34.4%; p=0.003). Development of moderate or severe aortic regurgitation was more common following TAVR (14% vs 1%; p<0·0001) and this was associated with higher mortality at 5 years (72.4% for moderate or severe aortic regurgitation compared with 56.6% for those with mild aortic regurgitation or less; p=0·003).
Conclusion: Outcomes from the original PARTNER study continue to demonstrate that TAVR is a suitable alternative to SAVR in high-risk patients with aortic stenosis. The overall mortality of greater than 60% at 5 years following both TAVR and SAVR in this population is striking. Although advances in TAVR technology, improved imaging and valve sizing, and operator experience may lead to better outcomes, the underlying risk of mortality related to comorbid illness remains important to discuss with patients considering either approach to the management of severe aortic stenosis.
Summarized by Jehu S. Mathew and Steven M. Bradley
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