- For patients with degenerated surgical bioprosthetic aortic valves undergoing transcatheter aortic valve replacement (TAVR), early improvements in functional status are maintained at the 3-year mark, and left ventricular performance is improved.
- Mortality compared well with that of high-risk patients undergoing valve replacement for native aortic stenosis in PARTNER cohort A (TAVR, 44.2%; surgery, 44.8%).
Why this matters
- Despite early postprocedural improvements, little is known about outcomes beyond 1 year after this procedure.
- At 3 years:
- Mortality, 32.7%; cardiac mortality, 20.5%; stroke, 6.2%; repeat aortic valve replacement, 1.9%.
- On echocardiogram, no significant difference between 30-day and 3-year measurements of mean effective orifice area or mean gradient.
- Total regurgitation: less than mild in 97.5%, moderate in 2.5%, severe in none.
- New York Heart Association functional class III or IV: 10.4% of patients at 30 days and 14.1% at 3 years, vs 90.4% at baseline.
- Left ventricular indices improved significantly.
- Prospective multicenter PARTNER 2’s nested valve-in-valve and continued-access registries (n=365).
- Participants had symptomatic degeneration of surgical aortic bioprostheses, were deemed at high risk (≥50% major morbidity or mortality) for reoperative surgery, and underwent valve-in-valve procedures.
- Outcomes included 3-year mortality, repeat valve replacement.
- Funding: Edwards Lifesciences.
- No randomized comparator arm; nonblinded.