Outcomes in 937 Intermediate-Risk Patients Undergoing Surgical Aortic Valve Replacement in PARTNER 2A.

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Citation: Annals of Thoracic Surgery. 105(5):1322-1329, 2018 05.PMID: 29253463Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aortic Valve Stenosis/su [Surgery] | *Postoperative Complications/ep [Epidemiology] | *Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Aged | Aged, 80 and over | Aortic Valve Stenosis/mo [Mortality] | Cohort Studies | Female | Hospital Mortality | Humans | Length of Stay | Male | Risk Factors | Survival Rate | Treatment OutcomeYear: 2018Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0003-4975
Name of journal: The Annals of thoracic surgeryAbstract: BACKGROUND: The PARTNER-2A randomized trial compared outcomes of transfemoral transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in intermediate-risk patients with severe aortic stenosis. The purpose of the current study was to perform an in-depth analysis of outcomes after SAVR in PARTNER-2A.CONCLUSIONS: In this adjudicated prospective study, SAVR in intermediate-risk patients had excellent results at 2 years. However, there were more in-hospital strokes than expected, most likely attributable to mandatory neurologic assessment post-procedure. There was no significant structural valve deterioration during 2-year follow-up. Continued long-term surveillance remains important. Copyright (c) 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.METHODS: From 1/2012-1/2014, 937 patients underwent SAVR at 57 centers. Mean age was 82+/-6.7 and 55% were men. Less-invasive operations were performed in 140 (15%) and concomitant procedures in 198 (21%). Major outcomes and echocardiograms were adjudicated by an independent events committee. Follow-up was 94% complete to 2 years.RESULTS: Operative mortality was 4.1% (n=38, STS PROM 5.2+/-2.3%), O/E 0.8, and in-hospital stroke 5.4% (n=51), twice expected. Aortic clamp and bypass times were 75+/-30 and 104+/-46 minutes. Patients having severe prosthesis-patient mismatch (n=260, 33%) had similar survival to those without (P>.9), as did those undergoing less-invasive SAVR (P=.3). Risk factors for death included cachexia (P=.004), tricuspid regurgitation (P=.01), coronary artery disease (P=.02), preoperative atrial fibrillation (P=.001), higher white cell count (P<.0001), and lower hemoglobin (P=.0002).All authors: Ailawadi G, Alu MC, Babaliaros VC, Bavaria JE, Blackstone EH, Corso PJ, Forcillo J, Greason KL, Hahn RT, Herrmann HC, Jaber WA, Kapadia S, Kodali SK, Leon MB, Lowry AM, Mack MJ, Makkar RR, Maniar HS, Miller DC, PARTNER Trial Investigators, Pichard AD, Rajeswaran J, Semple M, Smith CR, Suri RM, Svensson LG, Szeto WY, Thourani VH, Trento A, Williams MRFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2018-01-18
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 29253463 Available 29253463

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

BACKGROUND: The PARTNER-2A randomized trial compared outcomes of transfemoral transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in intermediate-risk patients with severe aortic stenosis. The purpose of the current study was to perform an in-depth analysis of outcomes after SAVR in PARTNER-2A.

CONCLUSIONS: In this adjudicated prospective study, SAVR in intermediate-risk patients had excellent results at 2 years. However, there were more in-hospital strokes than expected, most likely attributable to mandatory neurologic assessment post-procedure. There was no significant structural valve deterioration during 2-year follow-up. Continued long-term surveillance remains important. Copyright (c) 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

METHODS: From 1/2012-1/2014, 937 patients underwent SAVR at 57 centers. Mean age was 82+/-6.7 and 55% were men. Less-invasive operations were performed in 140 (15%) and concomitant procedures in 198 (21%). Major outcomes and echocardiograms were adjudicated by an independent events committee. Follow-up was 94% complete to 2 years.

RESULTS: Operative mortality was 4.1% (n=38, STS PROM 5.2+/-2.3%), O/E 0.8, and in-hospital stroke 5.4% (n=51), twice expected. Aortic clamp and bypass times were 75+/-30 and 104+/-46 minutes. Patients having severe prosthesis-patient mismatch (n=260, 33%) had similar survival to those without (P>.9), as did those undergoing less-invasive SAVR (P=.3). Risk factors for death included cachexia (P=.004), tricuspid regurgitation (P=.01), coronary artery disease (P=.02), preoperative atrial fibrillation (P=.001), higher white cell count (P<.0001), and lower hemoglobin (P=.0002).

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