MedStar Authors catalog › Details for: Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement.
Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement. Journal: The New England journal of medicine.Published: 2020; ISSN: 0028-4793.UI/PMID: 31995682.Subject(s): *Aortic Valve Stenosis/su [Surgery] | *Heart Valve Prosthesis | *Heart Valve Prosthesis Implantation/mt [Methods] | *Transcatheter Aortic Valve Replacement | Aged | Aged, 80 and over | Aortic Valve Insufficiency/et [Etiology] | Aortic Valve Insufficiency/pp [Physiopathology] | Aortic Valve Stenosis/co [Complications] | Aortic Valve Stenosis/dg [Diagnostic Imaging] | Aortic Valve Stenosis/mo [Mortality] | Aortic Valve/dg [Diagnostic Imaging] | Aortic Valve/su [Surgery] | Cohort Studies | Echocardiography | Female | Health Status | Humans | Incidence | Intention to Treat Analysis | Kaplan-Meier Estimate | Male | Multivariate Analysis | Postoperative Complications/mo [Mortality] | Risk Factors | Stroke/ep [Epidemiology] | Stroke/et [Etiology] | 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/10.1056/NEJMoa1910555 (Click here) Abbreviated citation: N Engl J Med. 382(9), 2020 02 27.Local Holdings: Available online from MWHC library: 1993 - present, Available in print through MWHC library: 1980 - present.Abstract: BACKGROUND: There are scant data on long-term clinical outcomes and bioprosthetic-valve function after transcatheter aortic-valve replacement (TAVR) as compared with surgical aortic-valve replacement in patients with severe aortic stenosis and intermediate surgical risk.Abstract: CONCLUSIONS: Among patients with aortic stenosis who were at intermediate surgical risk, there was no significant difference in the incidence of death or disabling stroke at 5 years after TAVR as compared with surgical aortic-valve replacement. (Funded by Edwards Lifesciences; PARTNER 2 ClinicalTrials.gov number, NCT01314313.). Copyright (c) 2020 Massachusetts Medical Society.Abstract: METHODS: We enrolled 2032 intermediate-risk patients with severe, symptomatic aortic stenosis at 57 centers. Patients were stratified according to intended transfemoral or transthoracic access (76.3% and 23.7%, respectively) and were randomly assigned to undergo either TAVR or surgical replacement. Clinical, echocardiographic, and health-status outcomes were followed for 5 years. The primary end point was death from any cause or disabling stroke.Abstract: RESULTS: At 5 years, there was no significant difference in the incidence of death from any cause or disabling stroke between the TAVR group and the surgery group (47.9% and 43.4%, respectively; hazard ratio, 1.09; 95% confidence interval [CI], 0.95 to 1.25; P = 0.21). Results were similar for the transfemoral-access cohort (44.5% and 42.0%, respectively; hazard ratio, 1.02; 95% CI, 0.87 to 1.20), but the incidence of death or disabling stroke was higher after TAVR than after surgery in the transthoracic-access cohort (59.3% vs. 48.3%; hazard ratio, 1.32; 95% CI, 1.02 to 1.71). At 5 years, more patients in the TAVR group than in the surgery group had at least mild paravalvular aortic regurgitation (33.3% vs. 6.3%). Repeat hospitalizations were more frequent after TAVR than after surgery (33.3% vs. 25.2%), as were aortic-valve reinterventions (3.2% vs. 0.8%). Improvement in health status at 5 years was similar for TAVR and surgery.