Transcatheter aortic valve replacement outcomes are similar to surgical aortic valve replacement outcomes at 5 years

Référence

Makkar RR, Thourani VH, Mack MJ, et al, for the PARTNER 2 Investigators. Five-year outcomes of transcatheter or surgical aortic-valve replacement. N Engl J Med 2020;382(9):799-809.

Sommaire

This is the 5-year follow-up of the outcomes of the PARTNER 2 trial . In this study, intermediate-risk patients with symptomatic severe aortic stenosis were randomized to receive either TAVR (n = 1011) or surgical valve replacement (n = 1021). The 2 groups were similar at baseline with a mean age of 81 years; a predicted 30-day operative mortality of 5.8%; and similar incidences of coronary artery disease, previous coronary artery bypass graft surgery, and previous percutaneous coronary interventions. Data was available at 5 years for 91% of patients in the TAVR group and 81% in the surgery group. There was no significant difference between the 2 groups for the composite outcome of all-cause death or disabling stroke at 5 years (48% in TAVR group vs 43% in surgery group; P = 0.21). The TAVR group was more likely to be re-hospitalized (33.3% vs 25.2%; hazard ratio [HR] 1.28; 95% CI 1.07-1.53) and require re-intervention of the aortic valve (3.2% vs 0.8%; HR 3.28; 1.32-8.13), but less likely to have new-onset atrial fibrillation (15.8% vs 30.4%; HR 0.43; 0.35-0.53). The TAVR group had a higher incidence of paravalvular aortic regurgitation (33.3% vs 6.3%); however, this risk is reduced with the newer third-generation SAPIEN 3 valve device compared with the previous generation SAPIEN XT device used in this study. Both groups had improvement in functional status and quality of life at 5 years. .