Outcomes in 937 Intermediate-Risk Patients Undergoing Surgical Aortic Valve Replacement in PARTNER-2A.
Publication/Presentation Date
5-1-2018
Abstract
BACKGROUND: The Placement of Aortic Transcatheter Valves 2A (PARTNER-2A) randomized trial compared outcomes of transfemoral transcatheter and surgical aortic valve replacement (SAVR) in intermediate-risk patients with severe aortic stenosis. The purpose of the present study was to perform an in-depth analysis of outcomes after SAVR in the PARTNER-2A trial.
METHODS: From January 2012 to January 2014, 937 patients underwent SAVR at 57 centers. Mean age was 82 ± 6.7 years and 55% were men. Less-invasive operations were performed in 140 patients (15%) and concomitant procedures in 198 patients (21%). Major outcomes and echocardiograms were adjudicated by an independent events committee. Follow-up was 94% complete to 2 years.
RESULTS: Operative mortality was 4.1% (n = 38, Society of Thoracic Surgeons predicted risk of mortality: 5.2% ± 2.3%), observed to expected ratio (O/E) was 0.8, and in-hospital stroke was 5.4% (n = 51), twice expected. Aortic clamp and bypass times were 75 ± 30 minutes and 104 ± 46 minutes, respectively. Patients having severe prosthesis-patient mismatch (n = 260, 33%) had similar survival to patients without (p > 0.9), as did patients undergoing less-invasive SAVR (p = 0.3). Risk factors for death included cachexia (p = 0.004), tricuspid regurgitation (p = 0.01), coronary artery disease (p = 0.02), preoperative atrial fibrillation (p = 0.001), higher white blood cell count (p < 0.0001), and lower hemoglobin (p = 0.0002).
CONCLUSIONS: In this adjudicated prospective study, SAVR in intermediate-risk patients had excellent results at 2 years. However, there were more in-hospital strokes than expected, most likely attributable to mandatory neurologic assessment after the procedure. No pronounced structural valve deterioration was found during 2-year follow-up. Continued long-term surveillance remains important.
Volume
105
Issue
5
First Page
1322
Last Page
1329
ISSN
1552-6259
Published In/Presented At
Thourani, V. H., Forcillo, J., Szeto, W. Y., Kodali, S. K., Blackstone, E. H., Lowry, A. M., Semple, M., Rajeswaran, J., Makkar, R. R., Williams, M. R., Bavaria, J. E., Herrmann, H. C., Maniar, H. S., Babaliaros, V. C., Smith, C. R., Trento, A., Corso, P. J., Pichard, A. D., Miller, D. C., Svensson, L. G., … PARTNER Trial Investigators (2018). Outcomes in 937 Intermediate-Risk Patients Undergoing Surgical Aortic Valve Replacement in PARTNER-2A. The Annals of thoracic surgery, 105(5), 1322–1329. https://doi.org/10.1016/j.athoracsur.2017.10.062
Disciplines
Medicine and Health Sciences
PubMedID
29253463
Department(s)
Department of Surgery
Document Type
Article