Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients

Abstract

Background: This study aimed to compare echocardiographic findings in low-risk patients with severe aortic stenosis after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Methods: The PARTNER 3 trial (Placement of Aortic Transcatheter Valves) randomized 1000 patients with severe aortic stenosis and low surgical risk to undergo either transfemoral TAVR with the balloon-expandable SAPIEN 3 valve or SAVR. Transthoracic echocardiograms obtained at baseline and at 30 days and 1 year after the procedure were analyzed by a consortium of 2 echocardiography core laboratories. Results: The percentage of moderate or severe aortic regurgitation (AR) was low and not statistically different between the TAVR and SAVR groups at 30 days (0.8% versus 0.2%; P =0.38). Mild AR was more frequent after TAVR than SAVR at 30 days (28.8% versus 4.2%; P <0.001). At 1 year, mean transvalvular gradient (13.7±5.6 versus 11.6±5.0 mm Hg; P =0.12) and aortic valve area (1.72±0.37 versus 1.76±0.42 cm 2 ; P =0.12) were similar in TAVR and SAVR. The percentage of severe prosthesis–patient mismatch at 30 days was low and similar between TAVR and SAVR (4.6 versus 6.3%; P =0.30). Valvulo-arterial impedance (Z va ), which reflects total left ventricular hemodynamic burden, was lower with TAVR than SAVR at 1 year (3.7±0.8 versus 3.9±0.9 mm Hg/mL/m 2 ; P <0.001). Tricuspid annulus plane systolic excursion decreased and the percentage of moderate or severe tricuspid regurgitation increased from baseline to 1 year in SAVR but remained unchanged in TAVR. Irrespective of treatment arm, high Z va and low tricuspid annulus plane systolic excursion, but not moderate to severe AR or severe prosthesis–patient mismatch, were associated with increased risk of the composite end point of mortality, stroke, and rehospitalization at 1 year. Conclusions: In patients with severe aortic stenosis and low surgical risk, TAVR with the SAPIEN 3 valve was associated with similar percentage of moderate or severe AR compared with SAVR but higher percentage of mild AR. Transprosthetic gradients, valve areas, percentage of severe prosthesis–patient mismatch, and left ventricular mass regression were similar in TAVR and SAVR. SAVR was associated with significant deterioration of right ventricular systolic function and greater tricuspid regurgitation, which persisted at 1 year. High Z va and low tricuspid annulus plane systolic excursion were associated with worse outcome at 1 year whereas AR and severe prosthesis–patient mismatch were not. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02675114.

Transcatheter aortic valve replacement using the SAPIEN 3 valve versus surgical aortic valve replacement using the rapid deployment INTUITY valve: Midterm outcomes

“…Notably, the gradient constancy after one year was more highly expressed in the RD‐SAVR group, which is consistent with the findings from other studies that used the INTUITY valve 26 . The S3 showed slightly elevated gradients after one year, which was largely consistent with the recently published echocardiographic results of the PARTNER 3 trial 27 …”

“…showed slightly elevated gradients after one year, which was largely consistent with the recently published echocardiographic results of the PARTNER 3 trial. 27…”

Long-Term Results (up to 20 Years) of 19 mm or Smaller Prostheses in the Aortic Position. Does Size Matter? A Propensity-Matched Survival Analysis

“…Its incidence has increased due to the longer life expectancy afforded by advances in healthcare. While aortic valve treatment has been traditionally reserved for open surgery, the development of TAVR has challenged this [ 9 , 10 , 11 ]. Surgeons tend to strive to implant a prosthesis as big as possible, with the goal of delivering a low-gradient, high EOA valve, that would mimic, as close as possible, a healthy, normal, functioning aortic valve.…”

Uncertainty Resolved?

“…The rate of mild paravalvular leak (PVL) was 2.1% in SAVR and 29.4% in TAVR. 6 While in the Evolut LR trial, the hemodynamic profile was advantageous, the rate of moderate PVL was higher as with surgery and one third of the patients had mild PVL at 1 year. There are conflicting results of the importance of mild PVL for long-term prognosis after AVR, but this may only be due to the fact that long-term data are still missing.…”