Here are the main results of the much anticipated PARTNER A trial comparing transcatheter aortic valve implantation (TAVI) versus surgery for aortic valve replacement (AVR). They were presented this morning in New Orleans at the ACC.<\/p>\n
Some 699 high-risk older patients with severe aortic stenosis were randomized to either TAVI or AVR.\u00a0 The primary endpoint, all-cause mortality at 1 year, was 24.2% in the TAVI group and 26.8%\u00a0 in the AVR group (HR 0.93, CI 0.71-1.22, p=0.62), thereby meeting the prespecified margin for noninferiority. Thirty-day mortality was 3.4% and 6.5%, respectively (p=0.07).<\/p>\n
The rate of major stroke at 1 year was 5.1% for TAVI versus 2.4% for AVR (p=0.07). For all strokes, the difference achieved statistical significance: 8.3% versus 4.3% (p=0.04). There were no significant differences at either 30 days or 1 year in cardiac mortality, rehospitalization, MI, or acute renal injury requiring renal replacement therapy.<\/p>\n
Major vascular complications occurred more frequently with TAVI, both at 30 days (11% versus 3.2%, p<0.01) and at 1 year (11.3% versus 3.5%, p<0.01). Major bleeding, on the other hand, occurred more often with AVR, both at 30 days (9.3% versus 19.5%, p<0.01) and at 1 year (14.7% versus 25.7%, p<0.01).<\/p>\n
New AF occurred more frequently in the surgery group: 12.1% versus 17.1% at 1 year (p=0.07).<\/p>\n
The rate of all-cause mortality or stroke was 26.5% for TAVI versus 28% for AVR (p=0.70).<\/p>\n
The authors conclude: \u201cBoth [TAVI] and AVR were associated with important\u000b but different peri-procedural hazards: Major strokes at 30 days and one \u000byear and major vascular complications were more frequent with [TAVI.] Major bleeding and new onset atrial fibrillation were more frequent with AVR. [TAVI] and AVR are both acceptable therapies in these \u000b high-risk patients; differing peri-procedural hazards\u000b may impact case-based decision-making.\u201d<\/p>\n
View Rick Lange’s<\/strong> Interventional Cardiology blog on the PARTNER A trial here<\/a>, and for more of our ACC.11 coverage of late-breaking clinical trials, interviews with the authors of the most important research, and blogs from our fellows on the most interesting presentations at the meeting, check out our Coverage Roundup<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" Here are the main results of the much anticipated PARTNER A trial comparing transcatheter aortic valve implantation (TAVI) versus surgery for aortic valve replacement (AVR). They were presented this morning in New Orleans at the ACC. Some 699 high-risk older patients with severe aortic stenosis were randomized to either TAVI or AVR.\u00a0 The primary endpoint, […]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20,9],"tags":[424,423,770],"class_list":["post-7362","post","type-post","status-publish","format-standard","hentry","category-cardiac-surgery","category-interventional-cardiology","tag-aortic-valve-replacement","tag-tavi","tag-tavr"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/7362","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=7362"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/7362\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=7362"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=7362"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=7362"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}