TY - JOUR
T1 - Hemodynamic outcomes of transcatheter aortic valve replacement and medical management in severe, inoperable aortic stenosis
T2 - A longitudinal echocardiographic study of cohort B of the PARTNER trial
AU - Douglas, Pamela S.
AU - Hahn, Rebecca T.
AU - Pibarot, Philippe
AU - Weissman, Neil J.
AU - Stewart, William J.
AU - Xu, Ke
AU - Wang, Zuyue
AU - Lerakis, Stamatios
AU - Siegel, Robert
AU - Thompson, Christopher
AU - Gopal, Deepika
AU - Keane, Martin G.
AU - Svensson, Lars G.
AU - Tuzcu, E. Murat
AU - Smith, Craig R.
AU - Leon, Martin B.
N1 - Funding Information:
The PARTNER trial was funded by Edwards Lifesciences (Irvine, California) and designed collaboratively by the Steering Committee and the sponsor. The current data analyses were done independently at the Cardiovascular Research Foundation (New York, NY), supported by an unrestricted research grant from Edwards Lifesciences . The authors had unrestricted access to the study data, drafted the manuscript, made the decision to submit for publication, and guarantee the completeness and accuracy of its content.
Publisher Copyright:
© 2015 Published by Elsevier Inc.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Background: Inoperable aortic stenosis may be treated with either transcatheter aortic valve replacement (TAVR) or medical management (MM) with or without balloon aortic valvuloplasty (BAV). The aim of this study was to compare the long-term echocardiographic findings among TAVR, MM, and BAV in patients with severe, inoperable aortic stenosis. Methods: A total of 358 inoperable patients in the Placement of Aortic Transcatheter Valves trial were randomized to MM or TAVR. Echocardiograms obtained at baseline, 30 days, and 1, 2, and 3 years were analyzed by a central core laboratory. Results: At baseline, TAVR and MM were similar, with more frequent Society of Thoracic Surgeons score > 10 (51.7% vs 65.0%, P =.03) and larger end-systolic volumes (54.5 ± 29.3 vs 69.1 ± 48.0 mL, P =.03) in MM. By 30 days after TAVR, mean aortic valve gradient had decreased (from 43.8 ± 14.7 to 10.0 ± 4.3 mm Hg, P <.001), ejection fraction had increased (from 53.2 ± 12.4% to 56.7 ± 10.0%, P <.001), and left ventricular (LV) mass index had decreased (from 144.7 ± 36.1 to 140.0 ± 37.9 gm/m2, P <.05). After 1 year, aortic valve gradients and area were unchanged, while LV mass index had decreased by another 16 gm/m2 (to 124 gm/m2). By 30 days after BAV, mean aortic valve gradient had decreased from 43.4 ± 15.0 to 31.9 ± 11.1 mm Hg, while ejection fraction and LV mass index were unchanged; gradient reverted to baseline at 1 year. No changes in gradients or mass were seen in MM patients. Conclusions: TAVR results in immediate and sustained relief in pressure overload and improved LV systolic function, with continued regression of hypertrophy over 3 years. Poor clinical results with BAV are explained by the modest and transient reductions in pressure overload with BAV, which were not accompanied by improved LV function or remodeling. TAVR is the preferred treatment in eligible inoperable patients.
AB - Background: Inoperable aortic stenosis may be treated with either transcatheter aortic valve replacement (TAVR) or medical management (MM) with or without balloon aortic valvuloplasty (BAV). The aim of this study was to compare the long-term echocardiographic findings among TAVR, MM, and BAV in patients with severe, inoperable aortic stenosis. Methods: A total of 358 inoperable patients in the Placement of Aortic Transcatheter Valves trial were randomized to MM or TAVR. Echocardiograms obtained at baseline, 30 days, and 1, 2, and 3 years were analyzed by a central core laboratory. Results: At baseline, TAVR and MM were similar, with more frequent Society of Thoracic Surgeons score > 10 (51.7% vs 65.0%, P =.03) and larger end-systolic volumes (54.5 ± 29.3 vs 69.1 ± 48.0 mL, P =.03) in MM. By 30 days after TAVR, mean aortic valve gradient had decreased (from 43.8 ± 14.7 to 10.0 ± 4.3 mm Hg, P <.001), ejection fraction had increased (from 53.2 ± 12.4% to 56.7 ± 10.0%, P <.001), and left ventricular (LV) mass index had decreased (from 144.7 ± 36.1 to 140.0 ± 37.9 gm/m2, P <.05). After 1 year, aortic valve gradients and area were unchanged, while LV mass index had decreased by another 16 gm/m2 (to 124 gm/m2). By 30 days after BAV, mean aortic valve gradient had decreased from 43.4 ± 15.0 to 31.9 ± 11.1 mm Hg, while ejection fraction and LV mass index were unchanged; gradient reverted to baseline at 1 year. No changes in gradients or mass were seen in MM patients. Conclusions: TAVR results in immediate and sustained relief in pressure overload and improved LV systolic function, with continued regression of hypertrophy over 3 years. Poor clinical results with BAV are explained by the modest and transient reductions in pressure overload with BAV, which were not accompanied by improved LV function or remodeling. TAVR is the preferred treatment in eligible inoperable patients.
KW - Aortic stenosis
KW - Echocardiography
KW - Transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=84921481088&partnerID=8YFLogxK
U2 - 10.1016/j.echo.2014.10.009
DO - 10.1016/j.echo.2014.10.009
M3 - Article
C2 - 25455544
AN - SCOPUS:84921481088
VL - 28
SP - 210-217.e9
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
SN - 0894-7317
IS - 2
ER -