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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-, 2-, and 3-year data from the Placement of Aortic Transcatheter Valves study [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%2F14%2F30%2F9.atom\u0022\u003ENCT00530894\u003C\/a\u003E] showed significant reductions in all-cause mortality, cardiac mortality, and rehospitalization [Kapadia SR et al. \u003Cem\u003ECirculation\u003C\/em\u003E. 2014; Makkar RR et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2012; Leon MB et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2010]. This article reports the 5-year outcomes for the PARTNER 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\u003EValvular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\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\u003ECardiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ETranscatheter aortic valve replacement (TAVR) is the recommended treatment for \u201cinoperable\u201d patients with severe aortic stenosis (AS). One-, 2-, and 3-year data from the Placement of Aortic Transcatheter Valves study [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%2F14%2F30%2F9.atom\u0022\u003ENCT00530894\u003C\/a\u003E] showed significant reductions in all-cause mortality, cardiac mortality, and rehospitalization [Kapadia SR et al. \u003Cem\u003ECirculation\u003C\/em\u003E. 2014; Makkar RR et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2012; Leon MB et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2010]. Samir R. Kapadia, MD, Cleveland Clinic Foundation, Cleveland, Ohio, USA, reported the 5-year outcomes for the PARTNER trial. Benefits as to all-cause and cardiovascular (CV) mortality, repeat hospitalization, and functional status were sustained in the TAVR-treated patients compared with those given standard therapy. Valve durability was demonstrated with no increase in transvalvular gradient or attrition of valve area.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe PARTNER trial included patients (n = 358) with severe symptomatic AS with aortic value area \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\/second. Patients deemed \u201cinoperable\u201d (defined as risk of death or serious irreversible morbidity of AVR exceeding 50%) were assessed by a cardiologist and 2 surgeons. Participants were randomly assigned (1:1) to TAVR or standard therapy. After 3 years, 20 patients crossed over to TAVR from standard therapy.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe study\u0027s primary end point of all-cause mortality was evaluated when all patients reached 1-year follow-up. Key end points for the 5-year analysis included all-cause and cardiac mortality, rehospitalization, stroke, NYHA functional class, and echo-derived valve areas, transvalvular gradients, and paravalvular leak. Mortality outcomes were stratified by Society of Thoracic Surgeons (STS) risk score, paravalvular leak, and age.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAt baseline, subjects were mean age 83 years with mean STS scores between 11.2 and 12.1. Most (\u0026gt; 90%) were NYHA III or IV and about 70% had coronary artery disease; 46% were men. Creatinine values \u0026gt; 2 mg\/dL were present in 5.6% of TAVR patients and 9.6% receiving standard therapy. Frailty was 18.1% for TAVR and 28% for standard therapy. A porcelain aorta was present in 19% of TAVR subjects and 11.2% of patients receiving standard therapy (\u003Cem\u003EP\u003C\/em\u003E = .05). The incidence of chronic obstructive pulmonary disease was significantly higher in the standard therapy group (52.5% vs 41.3% in the TAVR group; \u003Cem\u003EP\u003C\/em\u003E = .04). Average chest wall radiation was 8.6%.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAt 5 years, all-cause mortality in the intention to treat (ITT) population was 93.6% for standard therapy and 71.8% for TAVR (HR, 0.50; 95% CI, 0.39 to 0.65; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .0001). Other key end point events are shown in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11909\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11909\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11909\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\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EEvents at 5 Years in ITT Population\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EThe mortality benefit was similar in elderly (\u0026gt; 85 years) patients compared with those \u2264 85 years. A CV mortality and all-cause mortality benefit was seen even in patients with high STS scores. Beyond early procedural risk of stroke in TAVR-treated patients, there was no persistent risk over 5 years of follow-up. Echocardiography showed a sustained increase in aortic valve area and decrease in transvalvular gradient after TAVR. Moderate and severe paravalvular leak was associated with a higher CV mortality particularly in patients with less comorbidity.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EDespite an increase risk of major stroke, TAVR is a beneficial treatment for patients with severe AS who are not suitable candidates for surgery.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 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\/14\/30\/9.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?nzosz1\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_tables.js?nzosz1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}