| A comprehensive review of the PARTNER trial. | |
| | |
MedLine Citation:
|
PMID: 23410766 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
|
OBJECTIVE: Percutaneous transcatheter aortic valve replacement was introduced in 2002, but its effectiveness remained to be assessed. METHODS: A prospective, randomized trial (the Placement of Aortic Transcatheter Valves, or PARTNER) was designed with 2 arms: PARTNER A (n = 699) for high-risk surgical patients (Society of Thoracic Surgeons score >10%, surgeon assessed risk of mortality >15%) and PARTNER B (n = 358, patients inoperable by assessment of 2 surgeons). PARTNER A patients were divided into femoral artery access transcatheter aortic valve replacement or none (n = 207), and then randomized to open aortic valve replacement (n = 351) or device (n = 348). Inclusion criteria included valve area <0.8 cm(2), gradient >40 mm Hg or peak >64 mm Hg, and survival >1 year. The end point of the study was 1-year mortality. RESULTS: Thirty-day mortality for PARTNER A was 3.4% for transcatheter aortic valve replacement and 6.5% for aortic valve replacement; 1-year mortality was 24.2% and 26.8%, respectively (P = .001 for noninferiority). The respective prevalence of stroke was 3.8% and 2.1% (P = .2), although for all neurologic events, the difference between transcatheter aortic valve replacement and aortic valve replacement was significant (P = .04), including 4.6% for femoral artery access transcatheter aortic valve replacement versus 1.4% for open aortic valve replacement (P = .05). For PARTNER B-transcatheter aortic valve replacement versus medical treatment-30-day mortality was 5.0% versus 2.8% (P = .41), and at 1 year, mortality was 30.7% versus 50.7% (P < .001), respectively. Hospitalization cost of transcatheter aortic valve replacement for PARTNER B was $78,542, or $50,200 per year of life gained. Analysis of PARTNER A strokes showed that hazard with transcatheter aortic valve replacement peaked early, but thereafter remained constant in relation to aortic valve replacement. Two-year PARTNER A data showed paravalvular regurgitation was associated with increased mortality, even when mild (P < .001). Continued access to transapical transcatheter aortic valve replacement (n = 853) showed a mortality of 8.2% and decline in strokes to 2.0%. Of the 1801 Cleveland Clinic patients reviewed to December 2010, 214 (12%) underwent transcatheter aortic valve replacement with a mortality of 1%; in 2011, 105 underwent transcatheter aortic valve replacement: 34 transapical aortic valve replacement, with no deaths, and 71 femoral artery access aortic valve replacement with 1 death. CONCLUSIONS: The PARTNER A and B trials showed that survival has been remarkably good, but stroke and perivalvular leakage require further device development. |
| | |
Authors:
|
Lars G Svensson; Murat Tuzcu; Samir Kapadia; Eugene H Blackstone; Eric E Roselli; A Marc Gillinov; Joseph F Sabik; Bruce W Lytle |
Related Documents
:
|
23293176 - A novel guidewire approach for handling acute-angle bifurcations: reversed guidewire te... 22920296 - Clinical and radiological profiles and outcomes in pediatric patients with intracranial... 23450866 - Bilateral iliac arterial thrombosis in an alpaca (vicugna pacos) cria. 23133746 - Pulmonary complications in patients with severe brain injury. 1483626 - Intraoperative echocardiography for diagnosis and treatment of aortic dissection. utili... 12663826 - Transrenal arteriovenous dialysis graft creation: survival and patency in a swine model. |
Publication Detail:
|
Type: Editorial |
Journal Detail:
|
Title: The Journal of thoracic and cardiovascular surgery Volume: 145 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2013 Mar |
Date Detail:
|
Created Date: 2013-02-15 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
|
Languages: eng Pagination: S11-6 Citation Subset: AIM; IM |
Copyright Information:
|
Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
|
Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: svenssl@ccf.org. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Advantage of a precurved fenestrated endograft for aortic arch disease: Simplified arch aneurysm tre...
Next Document: Treatment of aortic arch aneurysms with a modular transfemoral multibranched stent-graft: Initial ex...