MedStar Authors catalog › Details for: Effect of Mechanically Expanded vs Self-Expanding Transcatheter Aortic Valve Replacement on Mortality and Major Adverse Clinical Events in High-Risk Patients With Aortic Stenosis: The REPRISE III Randomized Clinical Trial.
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Effect of Mechanically Expanded vs Self-Expanding Transcatheter Aortic Valve Replacement on Mortality and Major Adverse Clinical Events in High-Risk Patients With Aortic Stenosis: The REPRISE III Randomized Clinical Trial.

by Waksman, Ron; Thourani, Vinod H.
Citation: JAMA. 319(1):27-37, 2018 01 02.Journal: JAMA.Published: 2018ISSN: 0098-7484.Full author list: Feldman TE; Reardon MJ; Rajagopal V; Makkar RR; Bajwa TK; Kleiman NS; Linke A; Kereiakes DJ; Waksman R; Thourani VH; Stoler RC; Mishkel GJ; Rizik DG; Iyer VS; Gleason TG; Tchetche D; Rovin JD; Buchbinder M; Meredith IT; Gotberg M; Bjursten H; Meduri C; Salinger MH; Allocco DJ; Dawkins KD.UI/PMID: 29297076.Subject(s): Aged | Aged, 80 and over | *Aortic Valve/su [Surgery] | Aortic Valve Stenosis/mo [Mortality] | *Aortic Valve Stenosis/su [Surgery] | Bioprosthesis | Cardiovascular Diseases/et [Etiology] | Cardiovascular Diseases/mo [Mortality] | Female | Follow-Up Studies | *Heart Valve Prosthesis | Humans | Male | Postoperative Complications/et [Etiology] | Prosthesis Design | Risk Factors | *Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Transcatheter Aortic Valve Replacement/mt [Methods] | Transcatheter Aortic Valve Replacement/mo [Mortality] | Treatment OutcomeInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal Article | Research Support, Non-U.S. Gov'tOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1001/jama.2017.19132 (Click here) Abbreviated citation: JAMA. 319(1):27-37, 2018 01 02.Local Holdings: Available online from MWHC library: 1998 - present, Available in print through MWHC library: 1999 - present.Abstract: Importance: Transcatheter aortic valve replacement (TAVR) is established for selected patients with severe aortic stenosis. However, limitations such as suboptimal deployment, conduction disturbances, and paravalvular leak occur.Abstract: Objective: To evaluate if a mechanically expanded valve (MEV) is noninferior to an approved self-expanding valve (SEV) in high-risk patients with aortic stenosis undergoing TAVR.Abstract: Design, Setting, and Participants: The REPRISE III trial was conducted in 912 patients with high or extreme risk and severe, symptomatic aortic stenosis at 55 centers in North America, Europe, and Australia between September 22, 2014, and December 24, 2015, with final follow-up on March 8, 2017.Abstract: Interventions: Participants were randomized in a 2:1 ratio to receive either an MEV (n = 607) or an SEV (n = 305).Abstract: Main Outcomes and Measures: The primary safety end point was the 30-day composite of all-cause mortality, stroke, life-threatening or major bleeding, stage 2/3 acute kidney injury, and major vascular complications tested for noninferiority (margin, 10.5%). The primary effectiveness end point was the 1-year composite of all-cause mortality, disabling stroke, and moderate or greater paravalvular leak tested for noninferiority (margin, 9.5%). If noninferiority criteria were met, the secondary end point of 1-year moderate or greater paravalvular leak was tested for superiority in the full analysis data set.Abstract: Results: Among 912 randomized patients (mean age, 82.8 [SD, 7.3] years; 463 [51%] women; predicted risk of mortality, 6.8%), 874 (96%) were evaluable at 1 year. The primary safety composite end point at 30 days occurred in 20.3% of MEV patients and 17.2% of SEV patients (difference, 3.1%; Farrington-Manning 97.5% CI, - to 8.3%; P=.003 for noninferiority). At 1 year, the primary effectiveness composite end point occurred in 15.4% with the MEV and 25.5% with the SEV (difference, -10.1%; Farrington-Manning 97.5% CI, - to -4.4%; P<.001 for noninferiority). The 1-year rates of moderate or severe paravalvular leak were 0.9% for the MEV and 6.8% for the SEV (difference, -6.1%; 95% CI, -9.6% to -2.6%; P<.001). The superiority analysis for primary effectiveness was statistically significant (difference, -10.2%; 95% CI, -16.3% to -4.0%; P<.001). The MEV had higher rates of new pacemaker implants (35.5% vs 19.6%; P<.001) and valve thrombosis (1.5% vs 0%) but lower rates of repeat procedures (0.2% vs 2.0%), valve-in-valve deployments (0% vs 3.7%), and valve malpositioning (0% vs 2.7%).Abstract: Conclusions and Relevance: Among high-risk patients with aortic stenosis, use of the MEV compared with the SEV did not result in inferior outcomes for the primary safety end point or the primary effectiveness end point. These findings suggest that the MEV may be a useful addition for TAVR in high-risk patients.Abstract: Trial Registration: ClinicalTrials.gov Identifier: NCT02202434.

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