An analysis of PARTNER 2 data published in the New England Journal of Medicine Jan. 29 suggests five-year post-op outcomes are similar among heart patients who undergo either transcatheter or surgical aortic valve replacement.
Though TAVR, in particular, has gained considerable popularity over the past decade as a noninvasive CV intervention, R.R. Makkar and colleagues said in NEJM that little data exists concerning the long-term outcomes of TAVR versus surgical AVR, TAVR’s open-heart counterpart. What we do know is limited in scope—PARTNER 3 data, presented last March at the American College of Cardiology’s scientific sessions in Las Vegas, found a considerable health benefit with TAVR at one year, and another study presented at TCT 2019 linked TAVR to better long-term health status than SAVR at six months and one year.
Analyses of AVR outcomes beyond one year, however, have been scarce.
“There are scant data on long-term clinical outcomes and bioprosthetic valve function after TAVR as compared with SAVR in patients with severe aortic stenosis and intermediate surgical risk,” Makkar et al. wrote.
A total of 2,032 intermediate-risk patients were included in the team’s analysis, all of whom had severe symptomatic AS and were treated at one of 57 medical centers. Patients were divided based on intended transfemoral or transthoracic access (76.3% and 23.7% of the pool, respectively), and randomized to treatment with either TAVR or conventional open-heart surgery.
Five years into follow-up, the authors didn’t note any significant difference in rates of death from any cause or disabling stroke between patients treated with TAVR and those treated with SAVR. Nearly half—47.9%—of the TAVR group met that primary endpoint, while 43.4% of the SAVR group did the same.
Makkar and colleagues said primary endpoint results were similar for both TAVR and SAVR patients who underwent transfemoral access, but the incidence of death or disabling stroke was more than 10% higher after TAVR than after SAVR in the transthoracic-access cohort. Repeat hospitalizations were also more common after TAVR than after surgery (33.3% vs. 25.2%, respectively), and at five years more patients in the TAVR group had at least mild paravalvular aortic regurgitation (33.3% vs. 6.3% in the SAVR group). Aortic valve reinterventions were also more common with TAVR patients, occurring in 3.2% of the TAVR group and just 0.8% of the SAVR group.
“Although aortic valve reintervention was uncommon, it was more frequent after TAVR than after surgery, and the causes of reintervention were distinctly different,” Makkar et al. wrote. “Reintervention after TAVR usually occurred after two years and was due to progressive aortic valve stenosis or regurgitation...In contrast, reintervention after surgery was most commonly due to endocarditis and was managed with repeat open-heart surgery, which resulted in a high surgical mortality.”
The authors said the nature of their trial and study group, whose average age was 81, make their results “inappropriate” to extrapolate to other patient populations, including younger people and those at a lower surgical risk.