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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\u003EOne-year data from the Placement of Aortic Transcatheter Valves Trial [PARTNER; \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%2F4%2F12.atom\u0022\u003ENCT00530894\u003C\/a\u003E] showed that survival rates were similar among high-risk patients with aortic stenosis who received either transcatheter aortic valve replacement or surgical replacement [Smith CR et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2011; Vinall M. \u003Cem\u003EMD Conference Express\u003C\/em\u003E: ACC 2011]. This article discusses outcomes after 2 years of follow-up in the PARTNER trial [Kodali SK et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012].\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\u003EValvular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EOne\u2013year data from the Placement of Aortic Transcatheter Valves Trial [PARTNER; \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%2F4%2F12.atom\u0022\u003ENCT00530894\u003C\/a\u003E] showed that survival rates were similar among high\u2013risk patients with aortic stenosis (AS) who received either transcatheter aortic valve replacement (TAVR) or surgical replacement [Smith CR et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2011; Vinall M. \u003Cem\u003EMD Conference Express: ACC 2011\u003C\/em\u003E]. Susheel K. Kodali, MD, Columbia University Medical Center, New York, New York, USA, presented outcomes after 2 years of follow\u2013up in the PARTNER trial [Kodali SK et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EInclusion criteria were severe symptomatic AS; an echo\u2013derived aortic\u2013valve area (AVA) \u22640.8 cm\u003Csup\u003E2\u003C\/sup\u003E (or AVA index \u0026lt;0.5 cm\u003Csup\u003E2\u003C\/sup\u003E\/m\u003Csup\u003E2\u003C\/sup\u003E) and a peak velocity \u226540 mm Hg (or peak jet velocity of \u0026gt;4.0 m\/s); NYHA \u2265II; and high surgical risk (ie, guideline\u2013predicted risk of operative mortality \u226515%, as determined by site surgeon and cardiologist). The risk score threshold was an STS score \u226510 [\u003Ca href=\u0022http:\/\/riskcalc.sts.org\/STSWebRiskCalc273\/de.aspx\u0022\u003Ehttp:\/\/riskcalc.sts.org\/STSWebRiskCalc273\/de.aspx\u003C\/a\u003E].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe primary endpoint of the randomized, multicenter trial was all\u2013cause mortality. Other endpoints included cardiovascular (CV) mortality, rehospitalization, strokes and transient ischemic attacks (TIAs), vascular and bleeding events, NYHA functional class, and echocardiographic measures of valve performance (including valve gradient\/areas and postprocedural aortic regurgitation [AR]).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAt 2 years, there were no significant differences in mortality from any cause between the TAVR group (33.9%; 95% CI, 28.9 to 39.0) and the SAVR group (35.0%; 95% CI, 29.8 to 40.2; p=0.78). CV mortality was also similar in the TAVR and SAVR groups (21.4% [95% CI, 16.8 to 26.0] and 20.5% [95% CI, 15.8 to 25.3], respectively; p=0.80).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe frequency of all neurological events (stroke or TIA) at 2 years was higher with TAVR than with surgical replacement (11.2% vs 6.5%; p=0.05). However, there was no significant difference in the number of overall strokes between the TAVR and SAVR groups (24 vs 20, respectively at 36 months; HR, 1.22; 95% CI, 0.67 to 2.23; p=0.52).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EModerate or severe paravalvular AR was more common after TAVR than after SAVR at both 1 and 2 years (7.0% vs 1.9% at 1 year; 6.9% vs 0.9% at 2 years; p\u0026lt;0.001 for both comparisons). The presence of paravalvular or any AR (mild, moderate, or severe vs none or trace) after TAVR was associated with increased late mortality (HR, 2.11; 95% CI, 1.43 to 3.10; p\u0026lt;0.001), underscoring the importance of close clinical follow\u2013up and echocardiography in patients after TAVR.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EDr. Kodali concluded that TAVR should be considered an option for patients with severe symptomatic AS who are high risk for SAVR. He noted that TAVR remained equivalent to SAVR, with similar rates of all\u2013cause and CV mortality, and that symptom improvement was similar in both groups. Although TAVR valve hemodynamics remained stable at 2 years, the more frequent late development of paravalvular and any significant AR following TAVR was associated with a doubling of late mortality.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EFuture research appears warranted to focus on further reducing periprocedural TAVR complications, including strokes, vascular events, and short\u2013 and long\u2013term risk and prevention of paravalvular AR.\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\/4\/12.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_openurl.js?nznhae\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}