Outcomes in 937 Intermediate-Risk Patients Undergoing Surgical Aortic Valve Replacement in PARTNER 2A.
- 2018
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).