HOT OFF THE PRESS!

Debra L. Beck and Eugene Braunwald, MD

Date Published: Feb 14, 2020

The PARTNER 2A trial compared the outcomes after transcatheter aortic valve replacement (TAVR) with the second-generation Sapien XT valve and surgical aortic valve replacement (SAVR) in 2032 patients (mean age, 82 years, 55% male) with severe aortic stenosis at intermediate risk for surgery. The trial was conducted at 57 centers and stratified patients according to intended transfemoral or transthoracic access (76.3% and 23.7%, respectively).

TAVR was similar to SAVR for the primary endpoint of all-cause death or disabling stroke at 2 years. Makkar et al now present the 5-year outcomes of the PARTNER 2A trial. Data were available at 5 years for 920 patients (91.0%) in the TAVR group and for 831 (81.4%) in the SAVR group.

No difference was seen in the composite endpoint of death or disabling stroke at 5 years (47.9% for TAVR and 43.4% for SAVR; hazard ratio [HR], 1.09; p=0.21). In the transfemoral access group, the incidence of death or disabling stroke was similar for both groups (44.5% and 42.0%, respectively; HR, 1.02; p=NS), but the rates were higher after TAVR vs. SAVR in the transthoracic-access group (59.3% vs. 48.3%, respectively; HR, 1.32; p<0.05).

Improvement in functional health status and quality of life was similar between groups. Valve hemodynamics were also similar, except paravalvular leak that was at least mild in severity was seen in 33.3% of the TAVR arm and 6.3% of the SAVR arm. Repeat hospitalizations were also more frequent with TAVR (33.3% vs. 25.2%), as were aortic-valve reinterventions (3.2% vs. 0.8%).

Summary

The main findings of the 5-year follow-up of the PARNTER 2a trial were that, among patients with aortic stenosis at intermediate surgical risk, there was no significant difference in the incidence of death or disabling stroke at 5 years after TAVR as compared with SAVR, but TAVR was associated with more paravalvular regurgitation, repeat hospitalization and aortic-valve reintervention. The Sapien XT is no longer in clinical use, which reduces the clinical applicability of these long-term findings, noted the authors.

References

• 1. Makkar RR, Thourani VH, Mack MJ, et al: Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement. N Engl J Med. 382(9): page. 27 Feb 2020. 31995682

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