Author + information
- Rebecca T. Hahn,
- Philippe Pibarot,
- William J. Stewart,
- Neil J. Weissman,
- Augusto Pichard,
- Howard C. Herrmann,
- Martin Leon,
- Susheel Kodali,
- Vinod Thourani,
- Lars Svensson and
- Pamela Douglas
The Placement of Aortic Transcatheter Valves (PARTNER) trial randomized patients with critical aortic stenosis 1:1 to surgical valve replacement (SAVR) or transcatheter valve replacement (TAVR). The medium term (2 yr) echocardiographic findings are presented.
For 699 patients randomized between TAVR and SAVR, echocardiograms obtained at baseline, discharge, 30 days, 6 months, 1 year, and 2 years post procedure were analyzed centrally in a core laboratory.
Both groups showed a significant decrease in AV gradients and increase in effective orifice area (EOA) (p < 0.0001) immediately after intervention; valve function remained stable over 2 years. Both groups showed a continuous reduction over 2 years in relative wall thickness and LV mass or LV mass index (p < 0.0001 compared to baseline) with no significant difference between groups in the percent LV mass regression at 2 yrs (p = 0.16). Compared to SAVR, TAVR resulted in larger indexed EOA (iEOA) (p = 0.038) with less prosthesis-patient mismatch (PPM) (p = 0.019) but more total AR and paravalvular AR (PAR) (p < 0.0001). Pre-TAVR echocardiographic univariate predictors of death were peak transaortic gradient and low LV diastolic volume. Pre-SAVR echocardiographic univariate predictors of death were low stroke volume index and greater MR severity. Post-TAVR echocardiographic univariate predictors of death were: smaller LV dimensions and volumes, lower EF, smaller EOA and presence of AR (or PAR). Post SAVR predictors of death were low LV volumes, low stroke volume, low EOA and PPM.
Using core-lab adjudicated echocardiographic data, patients randomized to both SAVR and TAVR show significant reductions in transaortic gradients and increase in EOA with no change over time, with similar LV mass regression and ventricular remodeling. Compared to SAVR, TAVR patients had consistently higher iEOA and lower PPM but more AR and PAR. Differences in predictors of death for TAVR versus SAVR may allow future refinement in patient selection.
Oral Contributions West, Room 3006
Saturday, March 09, 2013, 8:15 a.m.-8:30 a.m.
Session Title: Novel Applications of Echocardiography: Implications for Clinical Use
Abstract Category: 18. Imaging: Echo
Presentation Number: 909-4
- 2013 American College of Cardiology Foundation