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Outcomes of transcatheter and surgical aortic valve replacement in high-risk patients with aortic stenosis and left ventricular dysfunction: results from the Placement of Aortic Transcatheter Valves (PARTNER) trial (cohort A).

Publication ,  Journal Article
Elmariah, S; Palacios, IF; McAndrew, T; Hueter, I; Inglessis, I; Baker, JN; Kodali, S; Leon, MB; Svensson, L; Pibarot, P; Douglas, PS ...
Published in: Circ Cardiovasc Interv
December 2013

BACKGROUND: The Placement of Aortic Transcatheter Valves (PARTNER) trial demonstrated similar survival after transcatheter and surgical aortic valve replacement (TAVR and SAVR, respectively) in high-risk patients with symptomatic, severe aortic stenosis. The aim of this study was to evaluate the effect of left ventricular (LV) dysfunction on clinical outcomes after TAVR and SAVR and the impact of aortic valve replacement technique on LV function. METHODS AND RESULTS: The PARTNER trial randomized high-risk patients with severe aortic stenosis to TAVR or SAVR. Patients were stratified by the presence of LV ejection fraction (LVEF) <50%. All-cause mortality was similar for TAVR and SAVR at 30-days and 1 year regardless of baseline LV function and valve replacement technique. In patients with LV dysfunction, mean LVEF increased from 35.7±8.5% to 48.6±11.3% (P<0.0001) 1 year after TAVR and from 38.0±8.0% to 50.1±10.8% after SAVR (P<0.0001). Higher baseline LVEF (odds ratio, 0.90 [95% confidence interval, 0.86, 0.95]; P<0.0001) and previous permanent pacemaker (odds ratio, 0.34 [95% confidence interval, 0.15, 0.81]) were independently associated with reduced likelihood of ≥10% absolute LVEF improvement by 30 days; higher mean aortic valve gradient was associated with increased odds of LVEF improvement (odds ratio, 1.04 per 1 mm Hg [95% confidence interval, 1.01, 1.08]). Failure to improve LVEF by 30 days was associated with adverse 1-year outcomes after TAVR but not SAVR. CONCLUSIONS: In high-risk patients with severe aortic stenosis and LV dysfunction, mortality rates and LV functional recovery were comparable between valve replacement techniques. TAVR is a feasible alternative for patients with symptomatic severe aortic stenosis and LV dysfunction who are at high risk for SAVR. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.

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Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

December 2013

Volume

6

Issue

6

Start / End Page

604 / 614

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Survival Rate
  • Stroke Volume
  • Risk Factors
  • Recovery of Function
  • Pacemaker, Artificial
  • Male
  • Kaplan-Meier Estimate
  • Humans
 

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Elmariah, S., Palacios, I. F., McAndrew, T., Hueter, I., Inglessis, I., Baker, J. N., … PARTNER Investigators, . (2013). Outcomes of transcatheter and surgical aortic valve replacement in high-risk patients with aortic stenosis and left ventricular dysfunction: results from the Placement of Aortic Transcatheter Valves (PARTNER) trial (cohort A). Circ Cardiovasc Interv, 6(6), 604–614. https://doi.org/10.1161/CIRCINTERVENTIONS.113.000650
Elmariah, Sammy, Igor F. Palacios, Thomas McAndrew, Irene Hueter, Ignacio Inglessis, Joshua N. Baker, Susheel Kodali, et al. “Outcomes of transcatheter and surgical aortic valve replacement in high-risk patients with aortic stenosis and left ventricular dysfunction: results from the Placement of Aortic Transcatheter Valves (PARTNER) trial (cohort A).Circ Cardiovasc Interv 6, no. 6 (December 2013): 604–14. https://doi.org/10.1161/CIRCINTERVENTIONS.113.000650.
Elmariah S, Palacios IF, McAndrew T, Hueter I, Inglessis I, Baker JN, Kodali S, Leon MB, Svensson L, Pibarot P, Douglas PS, Fearon WF, Kirtane AJ, Maniar HS, Passeri JJ, PARTNER Investigators. Outcomes of transcatheter and surgical aortic valve replacement in high-risk patients with aortic stenosis and left ventricular dysfunction: results from the Placement of Aortic Transcatheter Valves (PARTNER) trial (cohort A). Circ Cardiovasc Interv. 2013 Dec;6(6):604–614.

Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

December 2013

Volume

6

Issue

6

Start / End Page

604 / 614

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Survival Rate
  • Stroke Volume
  • Risk Factors
  • Recovery of Function
  • Pacemaker, Artificial
  • Male
  • Kaplan-Meier Estimate
  • Humans