MedStar Authors catalog › Details for: Outcomes in 937 Intermediate-Risk Patients Undergoing Surgical Aortic Valve Replacement in PARTNER 2A.
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Outcomes in 937 Intermediate-Risk Patients Undergoing Surgical Aortic Valve Replacement in PARTNER 2A.

by Corso, Paul J; Pichard, Augusto D.
Citation: Annals of Thoracic Surgery. 105(5):1322-1329, 2018 05..Journal: The Annals of thoracic surgery.Published: ; 2018ISSN: 0003-4975.Full author list: Thourani VH; Forcillo J; Szeto WY; Kodali SK; Blackstone EH; Lowry AM; Semple M; Rajeswaran J; Makkar RR; Williams MR; Bavaria JE; Herrmann HC; Maniar HS; Babaliaros VC; Smith CR; Trento A; Corso PJ; Pichard AD; Miller DC; Svensson LG; Kapadia S; Ailawadi G; Suri RM; Greason KL; Hahn RT; Jaber WA; Alu MC; Leon MB; Mack MJ; PARTNER Trial Investigators.UI/PMID: 29253463.Subject(s): Aged | Aged, 80 and over | Aortic Valve Stenosis/mo [Mortality] | *Aortic Valve Stenosis/su [Surgery] | Cohort Studies | Female | Hospital Mortality | Humans | Length of Stay | Male | *Postoperative Complications/ep [Epidemiology] | Risk Factors | Survival Rate | *Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Treatment OutcomeInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: (Click here) Abbreviated citation: Ann Thorac Surg. 105(5):1322-1329, 2018 05.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007.Abstract: 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.Abstract: 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.Abstract: 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).Abstract: 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.

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