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Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: a longitudinal study of echocardiography parameters in cohort A of the PARTNER trial (placement of aortic transcatheter valves).

Publication ,  Journal Article
Hahn, RT; Pibarot, P; Stewart, WJ; Weissman, NJ; Gopalakrishnan, D; Keane, MG; Anwaruddin, S; Wang, Z; Bilsker, M; Lindman, BR; Herrmann, HC ...
Published in: J Am Coll Cardiol
June 25, 2013

OBJECTIVES: This study sought to compare echocardiographic findings in patients with critical aortic stenosis following surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). BACKGROUND: The PARTNER (Placement of Aortic Transcatheter Valves) trial randomized patients 1:1 to SAVR or TAVR. METHODS: Echocardiograms were obtained at baseline, discharge, 30 days, 6 months, 1 year, and 2 years after the procedure and analyzed in a core laboratory. For the analysis of post-implantation variables, the first interpretable study (≤6 months) was used. RESULTS: Both groups showed a decrease in aortic valve gradients and increase in effective orifice area (EOA) (p < 0.0001), which remained stable over 2 years. Compared with SAVR, TAVR resulted in larger indexed EOA (p = 0.038), less prosthesis-patient mismatch (p = 0.019), and more total and paravalvular aortic regurgitation (p < 0.0001). Baseline echocardiographic univariate predictors of death were lower peak transaortic gradient in TAVR patients, and low left ventricular diastolic volume, low stroke volume, and greater severity of mitral regurgitation in SAVR patients. Post-implantation echocardiographic univariate predictors of death were: larger left ventricular diastolic volume, left ventricular systolic volume and EOA, decreased ejection fraction, and greater aortic regurgitation in TAVR patients; and smaller left ventricular systolic and diastolic volumes, low stroke volume, smaller EOA, and prosthesis-patient mismatch in SAVR patients. CONCLUSIONS: Patients randomized to either SAVR or TAVR experience enduring, significant reductions in transaortic gradients and increase in EOA. Compared with SAVR, TAVR patients had higher indexed EOA, lower prosthesis-patient mismatch, and more aortic regurgitation. Univariate predictors of death for the TAVR and SAVR groups differed and might allow future refinement in patient selection. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

June 25, 2013

Volume

61

Issue

25

Start / End Page

2514 / 2521

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Severity of Illness Index
  • Male
  • Longitudinal Studies
  • Humans
  • Heart Valve Prosthesis Implantation
  • Follow-Up Studies
  • Female
  • Echocardiography
  • Cohort Studies
 

Citation

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Hahn, R. T., Pibarot, P., Stewart, W. J., Weissman, N. J., Gopalakrishnan, D., Keane, M. G., … Douglas, P. S. (2013). Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: a longitudinal study of echocardiography parameters in cohort A of the PARTNER trial (placement of aortic transcatheter valves). J Am Coll Cardiol, 61(25), 2514–2521. https://doi.org/10.1016/j.jacc.2013.02.087
Hahn, Rebecca T., Philippe Pibarot, William J. Stewart, Neil J. Weissman, Deepika Gopalakrishnan, Martin G. Keane, Saif Anwaruddin, et al. “Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: a longitudinal study of echocardiography parameters in cohort A of the PARTNER trial (placement of aortic transcatheter valves).J Am Coll Cardiol 61, no. 25 (June 25, 2013): 2514–21. https://doi.org/10.1016/j.jacc.2013.02.087.
Hahn RT, Pibarot P, Stewart WJ, Weissman NJ, Gopalakrishnan D, Keane MG, Anwaruddin S, Wang Z, Bilsker M, Lindman BR, Herrmann HC, Kodali SK, Makkar R, Thourani VH, Svensson LG, Akin JJ, Anderson WN, Leon MB, Douglas PS. Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: a longitudinal study of echocardiography parameters in cohort A of the PARTNER trial (placement of aortic transcatheter valves). J Am Coll Cardiol. 2013 Jun 25;61(25):2514–2521.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

June 25, 2013

Volume

61

Issue

25

Start / End Page

2514 / 2521

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Severity of Illness Index
  • Male
  • Longitudinal Studies
  • Humans
  • Heart Valve Prosthesis Implantation
  • Follow-Up Studies
  • Female
  • Echocardiography
  • Cohort Studies