Highlights from

ACC 2020

Together with World Congress of Cardiology

Virtual 28 - 30 March 2020

2-year results show non-significant outcomes TAVR vs surgery in severe aortic stenosis

In a defined population of severe symptomatic aortic stenosis patients who were at low surgical risk, transcatheter aortic valve replacement (TAVR) compared with surgery showed a reduction in death, stroke or cardiovascular (CV) rehospitalisation at 2 years. Between 1 and 2 years, however, TAVR patients experienced more stroke/death events, which resulted in no significant differences between both groups [1].

Prof. Michael Mack (Baylor Scott & White Heart Hospital, USA) presented the 2-year clinical and echocardiographic outcomes of the PARTNER 3 trial for low-risk patients with severe symptomatic aortic stenosis who were treated with the SAPIEN 3 TAVR system compared or surgery. A thousand patients were randomised 1:1 to TAVR and surgery; follow-up was done at 30 days, 6 months, and continuing annually through 10 years. The primary endpoint was a composite of all-cause mortality, stroke, or CV rehospitalisation at 1-year post-procedure. Participants had severe calcific aortic stenosis and low surgical risk; mean age was 73 years, and mean Short-Term Risk Calculator (STS) score was 1.9. At 2 years, 96.5% of participants were available for primary endpoint analysis.

At 1 year, the primary endpoint occurred in 15.6% of surgery patients and in 8.5% of TAVR patients. This was 17.4% versus 11.5%, respectively, at 2 years. Death at 1 year occurred in 2.5% of surgery patients versus 1.0% of TAVR patients at 1 year; at 2 years, this was 3.2% and 2.4%, respectively. The rates for stroke at 1 year were 3.3% and 1.2%, respectively, and 3.6% versus % at 2 years. At 2 years, 2.6% of TAVR patients had valve thrombosis versus 0.7% of surgery patients (P=0.02).

Limitations of the study included that the results only apply to the enrolled selected population, which excluded a large number of patients. Also, there was less follow-up data available in the surgical group as more patients withdrew from the study. Finally, it was pointed out that valve thrombosis definitions by VARC 2 criteria are outdated and may be exaggerated by recent CT imaging leaflet thickening studies, and that results reflect only 2-year outcomes, which makes long-term assessment of structural valve deterioration necessary.

  1. Leon MB, et al. Two-year Clinical And Echocardiographic Outcomes From The Partner 3 Low-risk Randomized Trial. Abstract 405-16. ACC/WCC 28-30 March 2020.

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