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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EResults from the Placement of Aortic Transcatheter Valve Trial [PARTNER B; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00530894\u0026amp;atom=%2Fspmdc%2F12%2F17%2F23.atom\u0022\u003ENCT00530894\u003C\/a\u003E] continue to support the role of transcatheter aortic valve replacement as the standard of care for symptomatic patients with aortic stenosis who are not surgical candidates, as presented 3-year follow-up findings from the PARTNER B trial.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EValvular Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EResults from the Placement of Aortic Transcatheter Valve Trial [PARTNER B; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00530894\u0026amp;atom=%2Fspmdc%2F12%2F17%2F23.atom\u0022\u003ENCT00530894\u003C\/a\u003E] continue to support the role of transcatheter aortic valve replacement (TAVR) as the standard of care for symptomatic patients with aortic stenosis who are not surgical candidates, said E. Murat Tuzcu, MD, Cleveland Clinic, Cleveland, Ohio, USA. Dr. Tuzcu presented 3-year follow-up findings from the PARTNER B trial.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe objectives of the trial were to evaluate the clinical outcomes of TAVR compared with standard therapy at 3 years in patients with inoperable aortic stenosis (iAS), to assess valve hemodynamics and durability using echocardiography, and to perform subgroup analyses to better define the impact of comorbidities on outcomes.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EA total of 358 patients with iAS were randomized (1:1) to receive a transcather heart valve or standard medical therapy. The inclusion criteria were severe calcific aortic stenosis, defined as an echo-derived valve area of \u0026lt;0.8 cm\u003Csup\u003E2\u003C\/sup\u003E (effective orifice area index \u0026lt;0.5 cm\u003Csup\u003E2\u003C\/sup\u003E\/m\u003Csup\u003E2\u003C\/sup\u003E), and mean gradient \u0026gt;40 mm Hg or jet velocity \u0026gt;4.0 m\/s; NYHA Class \u2265II; and inoperable, defined as risk of death or serious irreversible morbidity with surgical replacement \u0026gt;50% as assessed by a cardiologist and 2 surgeons.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EKey endpoints for the 3-year analysis were all-cause and cardiac mortality; rehospitalization; adverse outcomes, including stroke, bleeding, renal failure, or myocardial infarction; NYHA functional class; days alive and out of hospital; echo-derived valve areas, transvalvular gradients, and post-TAVR aortic regurgitation; and mortality outcomes stratified by the Society of Thoracic Surgeons mortality risk score.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EBaseline characteristics were similar between the 2 groups. The mean age was 83 years, and nearly half (46%) of the subjects were men. Patients in the standard-care group had significantly higher rates of chronic obstructive pulmonary disease compared with the TAVR group (52.5% vs 41.3%, respectively; p=0.04) and atrial fibrillation (48.8% vs 32.9%; p=0.04). The prevalence of porcelain aorta was 19.0% in the TAVR group versus 11.2% in the standard-care group (p=0.05).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe Kaplan-Meier estimated rates of all-cause mortality at 3 years were 80.9% in the standard-care arm versus 54.1% in the TAVR arm, an absolute reduction of 26.8% (HR, 0.53; 95% CI, 0.41 to 0.68; log-rank p\u0026lt;0.0001). The number needed to treat (NNT) was 3.7 patients (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Rates for cardiovascular mortality were similarly reduced from 74.5% to 41.4%, a 33.1% reduction with an NNT of 3.0 patients. Serial landmark analyses performed at baseline, 12 months, and 24 months demonstrate a consistent, significant reduction in all-cause mortality for TAVR as compared with standard care.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/17\/23\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022                Figure 1. All-Cause Mortality (ITT): Crossover Patients Censored at Crossover.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1069421351\u0022 data-figure-caption=\u0022                Figure 1. All-Cause Mortality (ITT): Crossover Patients Censored at Crossover.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/17\/23\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/17\/23\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/17\/23\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14281\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003E\n               \u003Ca id=\u0022xref-fig-1-2\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E. All-Cause Mortality (ITT): Crossover Patients Censored at Crossover.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EITT=intention-to-treat; TAVR= transcatheter aortic valve replacement.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from EM Tuzcu, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EBased on the data, Dr. Tuzcu concluded that the benefits of TAVR as measured by all-cause mortality, cardiovascular mortality, repeat hospitalization, and functional status were sustained through 3 years of follow-up. Durability of the implanted valves was also demonstrated with no increase in transvalvular gradient or attrition of valve area. Detailed analysis of all randomized inoperable patients showed consistent results for all outcomes. He also noted that survival benefit of TAVR is dependent on the presence of comorbid illness and, without TAVR, mortality is similar irrespective of comorbid illness.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EThree-year outcomes continue to support the role of TAVR as the standard of care for symptomatic patients with aortic stenosis who are not surgical candidates. \u201cThese data underscore the importance of patient selection before TAVR and the need for aggressive management of illnesses after TAVR,\u201d said Dr. Tuzcu.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/17\/23.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzn7cb\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn7cb\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}