Author + information
- Shikhar Agarwal,
- William Stewart,
- Lars Svensson,
- Navkaranbir Bajaj,
- E. Murat Tuzcu and
- Samir Kapadia
Transcatheter aortic valve replacement (TAVR) has emerged as an attractive alternative for treatment of high–risk severe aortic stenosis patients. Although several large multicenter registries have been published detailing outcomes after TAVR, only one randomized trial [PARTNER trial] has been published in this area. We aimed to compare the short–term and medium–term outcomes obtained using multicenter registries to those observed in the PARTNER trial.
Standard MEDLINE search strategy was used to find large multicenter registries, which reported clinical outcomes following TAVR. Meta–analytic techniques were utilized to calculate pooled outcomes across multicenter registries and subsequently compare them to those obtained in the PARTNER trial cohorts.
12 registries were included in the analysis. Pooled 30 day mortality rate from the registries was 9.2 %, which was significantly higher than that in the PARTNER trial [3.8%]. Medium term mortality rates were similar between the PARTNER trial and the multicenter registries. Pooled 30 day and 1 year stroke rates obtained from multicenter registries were 2.6% and 3.8% respectively. On the other hand, the corresponding rates in the PARTNER trial were 5.2% and 7.6% respectively. In the registry related transfemoral cohorts, pooled 30 day and 1 year mortality rates were 6.8% and 20.8% respectively. In the registry related transapical cohorts, pooled 30 day and 1 year mortality rates were 12.2% and 32.2% respectively. Among the PARTNER trial cohorts, the pooled incidence of 30 day and 1 year mortality rates were 3.9% and 26.2% in the transfemoral TAVR group and 3.8% and 29.0% in the transapical TAVR group.
Short–term results reported in the PARTNER trial appear to be better compared to those reported in the multicenter registries. This may be secondary to better patient selection, expert centers and more aggressive bailout techniques, which may have improved short–term Results. Similarity of medium term outcomes between registries and PARTNER trial highlights the fact that patient selection for TAVR is critical due to a considerable risk of mortality in the first year even after the successful procedure.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Structural Heart Disease Intervention
Abstract Category: 49. TCT@ACC–i2: Aortic Valve Disease
Presentation Number: 2114–239
- 2013 American College of Cardiology Foundation