TY  - BOOK
AU  - Corso, Paul J
TI  - Appropriate patient selection or health care rationing? Lessons from surgical aortic valve replacement in the Placement of Aortic Transcatheter Valves I trial
SN  - 0022-5223
PY  - 2015///
KW  - *Aortic Valve Stenosis/su [Surgery]
KW  - *Aortic Valve/su [Surgery]
KW  - *Health Care Rationing
KW  - *Heart Valve Prosthesis Implantation
KW  - *Patient Selection
KW  - *Process Assessment (Health Care)
KW  - Aged
KW  - Aged, 80 and over
KW  - Aortic Valve Stenosis/di [Diagnosis]
KW  - Aortic Valve Stenosis/mo [Mortality]
KW  - Benchmarking
KW  - Female
KW  - Health Care Rationing/st [Standards]
KW  - Heart Valve Prosthesis Implantation/ae [Adverse Effects]
KW  - Heart Valve Prosthesis Implantation/mo [Mortality]
KW  - Heart Valve Prosthesis Implantation/st [Standards]
KW  - Hospital Mortality
KW  - Humans
KW  - Kaplan-Meier Estimate
KW  - Male
KW  - Medical Futility
KW  - Postoperative Complications/mo [Mortality]
KW  - Process Assessment (Health Care)/st [Standards]
KW  - Risk Assessment
KW  - Risk Factors
KW  - Time Factors
KW  - Treatment Outcome
KW  - United States
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
KW  - Multicenter Study
KW  - Randomized Controlled Trial
N1  - Available online from MWHC library: 1994 - present, Available in print through MWHC library: 1999 - 2006
N2  - CONCLUSIONS: PARTNER selection criteria for surgical aortic valve replacement, with a few caveats, may be more appropriate, realistic indications for surgery than those of the past, reflecting contemporary surgical management of severe aortic stenosis in high-risk patients at experienced sites.Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved; METHODS: From May 2007 to October 2009, 699 patients with high surgical risk, aged 84 +/- 6.3 years, were randomized in PARTNER-IA; 313 patients underwent surgical aortic valve replacement. Median follow-up was 2.8 years. Survival for therapy without aortic valve replacement used 181 PARTNER-IB patients; OBJECTIVES: The study objectives were to (1) compare the safety of high-risk surgical aortic valve replacement in the Placement of Aortic Transcatheter Valves (PARTNER) I trial with Society of Thoracic Surgeons national benchmarks; (2) reference intermediate-term survival to that of the US population; and (3) identify subsets of patients for whom aortic valve replacement may be futile, with no survival benefit compared with therapy without aortic valve replacement; RESULTS: Operative mortality was 10.5% (expected 9.3%), stroke 2.6% (expected 3.5%), renal failure 5.8% (expected 12%), sternal wound infection 0.64% (expected 0.33%), and prolonged length of stay 26% (expected 18%). However, calibration of observed events in this relatively small sample was poor. Survival at 1, 2, 3, and 4 years was 75%, 68%, 57%, and 44%, respectively, lower than 90%, 81%, 73%, and 65%, respectively, in the US population, but higher than 53%, 32%, 21%, and 14%, respectively, in patients without aortic valve replacement. Risk factors for death included smaller body mass index, lower albumin, history of cancer, and prosthesis-patient mismatch. Within this high-risk aortic valve replacement group, only the 8% of patients with the poorest risk profiles had estimated 1-year survival less than that of similar patients treated without aortic valve replacement
UR  - http://dx.doi.org/10.1016/j.jtcvs.2015.05.073
ER  -