{"id":8247,"date":"2011-05-12T13:19:17","date_gmt":"2011-05-12T17:19:17","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=8247"},"modified":"2011-07-19T17:44:25","modified_gmt":"2011-07-19T21:44:25","slug":"tavi-stroke-more-details-surface-about-partner-a","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/05\/12\/tavi-stroke-more-details-surface-about-partner-a\/","title":{"rendered":"TAVI &#038; Stroke: More Details Surface About PARTNER A"},"content":{"rendered":"<p>In the past year transcatheter aortic valve implantation (TAVI) has emerged as a possible new treatment for  patients with aortic valve disease who are not surgical candidates (<a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1008232\">the PARTNER B study<\/a>) and for some patients as a viable alternative to surgery (<a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/partner-a-tavi-noninferior-to-surgery-but-stroke-might-be-a-problem\/\">the <\/a><a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/partner-a-tavi-noninferior-to-surgery-but-stroke-might-be-a-problem\/\">PARTNER A study<\/a>). TAVI was found  to be noninferior to surgery in the PARTNER A trial, however, a major  question lingers over the higher rate of stroke in the TAVI arm. In a presentation (<a href=\"http:\/\/www.aats.org\/multimedia\/files\/AnnualMeeting\/2011\/AATS11-MILLER-final-v-16-PARTNER-stroke.ppt\">PowerPoint slide set<\/a>) earlier this week at the annual meeting of the American Association for Thoracic Surgery, Craig Miller presented results of the PARTNER A stroke substudy.<\/p>\n<p>Overall, said Miller, the 30-day rate of stroke and TIA was low in both groups, considering the very high baseline risk of the patients:<\/p>\n<ul>\n<li>Surgery=2.6% versus TAVI=5.6% (p=0.05)<\/li>\n<\/ul>\n<p>PARTNER patients in whom the transfemoral (TF) approach was possible had an even lower risk of stroke and TIA:<\/p>\n<ul>\n<li>TF group: Surgery=1.4% versus TAVI=4.6% (p=0.04)<\/li>\n<\/ul>\n<p>Major stroke at 30 days:<\/p>\n<ul>\n<li>Surgery=2.3% versus TAVI=3.8% (p=0.25)<\/li>\n<li>TF group: Surgery=1.4% versus TAVI=2.5% (p=0.37)<\/li>\n<\/ul>\n<p>Miller reported that in the early phase the risk of stroke was elevated in the TAVI group, particularly in patients with a smaller AVA index. In the subsequent period, patients with a &#8220;generalized heavy arteriosclerotic burden&#8221; who were not candidates for the TF approach had a higher risk of stroke or TIA.<\/p>\n<p>&#8220;The higher observed incidence of neurological events in the &#8216;non-TF candidate&#8217; stratum reflected the patient substrate, and was not related to the transapical TAVR or AVR procedures per se,&#8221; he concluded.<\/p>\n<p>Stroke and TIA had a different effect on subsequent mortality depending on treatment group. In the surgery group, a neurological event was associated with an early high peak in mortality which quickly returned to baseline. In the TAVI group, the increase in mortality risk remained elevated during the 2-year follow-up period, especially in patients in the transapical group.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In the past year transcatheter aortic valve implantation (TAVI) has emerged as a possible new treatment for patients with aortic valve disease who are not surgical candidates (the PARTNER B study) and for some patients as a viable alternative to surgery (the PARTNER A study). TAVI was found to be noninferior to surgery in the [&hellip;]<\/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":[840,253,423],"class_list":["post-8247","post","type-post","status-publish","format-standard","hentry","category-cardiac-surgery","category-interventional-cardiology","tag-avr","tag-stroke","tag-tavi"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/8247","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=8247"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/8247\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=8247"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=8247"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=8247"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}