Comparison of Transcatheter and Surgical Aortic Valve Replacement in Severe Aortic Stenosis

• Authors: Rebecca T. Hahn, Columbia University; Philippe Pibarot, Laval University; William J. Stewart, Cleveland Clinic Foundation; Neil J. Weissman, Medstar Washington Hospital Center; Deepika Gopalakrishnan, Medical City Dallas; Martin G. Keane, University of Pennsylvania; Saif Anwaruddin, University of Pennsylvania; Zueyue Wang, Medstar Washington Hospital Center; Martin Bilsker, University of Miami; Brian R. Lindman, Washington University; Howard C. Herrmann, University of Pennsylvania; Susheel K. Kodali, Columbia University; Vinod Thourani, Emory University; Lars G. Svensson, Cleveland Clinic Foundation; Jodi J. Akin, Edwards Lifesciences; William N. Anderson, Edwards Lifesciences; Martin Leon, Columbia University; Pamela S. Douglas, Duke University
• Journal Title: Journal of the American College of Cardiology
• Volume: Volume 61, Number 25
• Publisher: Elsevier: 12 months | 2013-06-25, Pages 2514-2521
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.jacc.2013.02.087
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; aortic stenosis; echocardiography; surgical aortic valve replacement; transcatheter aortic valve replacement; OF-CARDIOLOGY FOUNDATION; HIGH-RISK PATIENTS; PARAVALVULAR REGURGITATION; AMERICAN-SOCIETY; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; EUROPEAN-ASSOCIATION; STANDARDS COMMITTEE; IMPLANTATION; RECOMMENDATIONS; OUTCOMES

Abstract

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.