TY  - BOOK
AU  - Pichard, Augusto D
TI  - Long-term outcomes of inoperable patients with aortic stenosis randomly assigned to transcatheter aortic valve replacement or standard therapy
SN  - 0009-7322
KW  - *Aortic Valve Stenosis/mo [Mortality]
KW  - *Aortic Valve Stenosis/th [Therapy]
KW  - *Transcatheter Aortic Valve Replacement/mo [Mortality]
KW  - *Transcatheter Aortic Valve Replacement/mt [Methods]
KW  - Aged
KW  - Aged, 80 and over
KW  - Aortic Valve Insufficiency/mo [Mortality]
KW  - Aortic Valve Insufficiency/th [Therapy]
KW  - Cardiac Catheterization
KW  - Female
KW  - Follow-Up Studies
KW  - Hemodynamics
KW  - Hemorrhage/et [Etiology]
KW  - Hemorrhage/mo [Mortality]
KW  - Humans
KW  - Kaplan-Meier Estimate
KW  - Male
KW  - Outcome Assessment (Health Care)
KW  - Patient Readmission/sn [Statistics & Numerical Data]
KW  - Proportional Hazards Models
KW  - Stroke/et [Etiology]
KW  - Stroke/mo [Mortality]
KW  - Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
KW  - Treatment Outcome
KW  - MedStar Heart & Vascular Institute
KW  - Comparative Study
KW  - Journal Article
KW  - Randomized Controlled Trial
KW  - Research Support, Non-U.S. Gov't
N1  - Available online from MWHC library: 1950 - present, Available in print through MWHC library: 1999 - 2006
N2  - BACKGROUND: The long-term outcomes of transcatheter aortic valve replacement (TAVR) in inoperable patients with severe aortic stenosis remain unknown; CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.Copyright � 2014 American Heart Association, Inc; CONCLUSIONS: TAVR resulted in better survival and functional status in inoperable patients with severe aortic stenosis with durable hemodynamic benefit on long-term follow-up. However, high residual mortality, even in successfully treated TAVR patients, highlights the need for more strategic patient selection; METHODS AND RESULTS: In the Placement of Aortic Transcatheter Valves (PARTNER) study, 358 patients were randomly assigned to TAVR or standard therapy. We report the 3-year outcomes on these patients, and the pooled outcomes for all randomly assigned inoperable patients (n=449) in PARTNER, as well, including the randomized portion of the continued access study (n=91). The 3-year mortality rate in the TAVR and standard therapy groups was 54.1% and 80.9%, respectively (P<0.001; hazard ratio, 0.53; 95% confidence interval, 0.41-0.68; P<0.001). In survivors, there was significant improvement in New York Heart Association functional class sustained at 3 years. The cumulative incidence of strokes at 3-year follow-up was 15.7% in TAVR patients versus 5.5% in patients undergoing standard therapy (hazard ratio, 2.81; 95% confidence interval, 1.26-6.26; P=0.012); however, the composite of death or strokes was significantly lower after TAVR versus standard therapy (57.4% versus 80.9%, P<0.001; hazard ratio, 0.60; 95% confidence interval, 0.46-0.77; P<0.001). Echocardiography showed a sustained increase in aortic valve area and decrease in transvalvular gradient after TAVR. Analysis of the 449 pooled randomly assigned patients (TAVR, n=220; standard therapy, n=229) demonstrated significant improvement in all-cause mortality and functional status during early and 3-year follow-up. The results of the pooled cohort were similar to the results obtained from the pivotal PARTNER trial
UR  - http://dx.doi.org/10.1161/CIRCULATIONAHA.114.009834
ER  -