TAVR for intermediate-risk patients: the PARTNER 2 trial

Sunday, April 3, 2016

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Source

Source Name: N Engl J Med

Source URL: http://www.nejm.org/doi/full/10.1056/NEJMoa1514616

Author(s)

Martin B. Leon, Craig R. Smith, Michael J. Mack, Raj R. Makkar, Lars G. Svensson, Susheel K. Kodali, Vinod H. Thourani, E. Murat Tuzcu, D. Craig Miller, Howard C. Herrmann, Darshan Doshi, David J. Cohen, Augusto D. Pichard, Samir Kapadia, Todd Dewey, Vasilis Babaliaros, Wilson Y. Szeto, Mathew R. Williams, Dean Kereiakes, Alan Zajarias, Kevin L. Greason, Brian K. Whisenant, Robert W. Hodson, Jeffrey W. Moses, Alfredo Trento, David L. Brown, William F. Fearon, Philippe Pibarot, Rebecca T. Hahn, Wael A. Jaber, William N. Anderson, Maria C. Alu, and John G. Webb, for the PARTNER 2 Investigators

The PARTNER 2A trial randomized 2032 patients at intermediate operative risk (mean STS score of 6) to undergo either transcatheter or surgical aortic valve replacement. The primary endpoint of all-cause death or disabling stroke at 2 years was comparable for the two treatments: TAVR 19.3% versus SAVR 21.1%. A subgroup analysis of patients eligible for transfemoral aortic valve replacement even suggested superior outcomes for TAVR as compared to surgery (HR 0.79, 95% CI 0.62-1.00, P=0.05).

Comments

Submitted by Constantinos Lovoulos on Fri, 2016-04-22 18:16

In case of TAVR bio prosthetic failure over time, size limitations, or another type of cardiac pathology (CAD or MV disease), the need for another cardiothoracic surgical intervention arises via mediasternotomy or minimally invasive approach, do the authors have any comments on the degree of difficulty of entering the pericardial cavity? Considering the deployment forces of the TAVR valve I would expect a cemented aorta to the PA, RA, and RV. By constantly broadening the candidate population for TAVR, are we indicating to our patients that in 5, 10 or 15 years we will not be implanting mechanical aortic valves?

Submitted by Ghassan Musleh on Sat, 2016-04-23 02:34

One of the main limitations of TAVR is the lack of knowledge about its intermediate and long term durability. Doing more TAVR in low risk cases means the high chance they will come for redo valve wheather it is TAVR OR SAVR. in case the patient needed surgery then It will be an operation from hell.