Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: A longitudinal study of echocardiography parameters in cohort a of the PARTNER trial (Placement of aortic transcatheter valves)

Rebecca T. Hahn, Philippe Pibarot, William J. Stewart, Neil J. Weissman, Deepika Gopalakrishnan, Martin G. Keane, Saif Anwaruddin, Zuyue Wang, Martin S Bilsker, Brian R. Lindman, Howard C. Herrmann, Susheel K. Kodali, Raj Makkar, Vinod H. Thourani, Lars G. Svensson, Jodi J. Akin, William N. Anderson, Martin B. Leon, Pamela S. Douglas

Research output: Contribution to journalArticle

149 Citations (Scopus)

Abstract

Objectives This study sought to compare echocardiographic findings in patients with critical aortic stenosis following surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Background The PARTNER (Placement of Aortic Transcatheter Valves) trial randomized patients 1:1 to SAVR or TAVR. Methods Echocardiograms were obtained at baseline, discharge, 30 days, 6 months, 1 year, and 2 years after the procedure and analyzed in a core laboratory. For the analysis of post-implantation variables, the first interpretable study (≤6 months) was used. Results Both groups showed a decrease in aortic valve gradients and increase in effective orifice area (EOA) (p < 0.0001), which remained stable over 2 years. Compared with SAVR, TAVR resulted in larger indexed EOA (p = 0.038), less prosthesis-patient mismatch (p = 0.019), and more total and paravalvular aortic regurgitation (p < 0.0001). Baseline echocardiographic univariate predictors of death were lower peak transaortic gradient in TAVR patients, and low left ventricular diastolic volume, low stroke volume, and greater severity of mitral regurgitation in SAVR patients. Post-implantation echocardiographic univariate predictors of death were: larger left ventricular diastolic volume, left ventricular systolic volume and EOA, decreased ejection fraction, and greater aortic regurgitation in TAVR patients; and smaller left ventricular systolic and diastolic volumes, low stroke volume, smaller EOA, and prosthesis-patient mismatch in SAVR patients. Conclusions Patients randomized to either SAVR or TAVR experience enduring, significant reductions in transaortic gradients and increase in EOA. Compared with SAVR, TAVR patients had higher indexed EOA, lower prosthesis-patient mismatch, and more aortic regurgitation. Univariate predictors of death for the TAVR and SAVR groups differed and might allow future refinement in patient selection. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).

Original languageEnglish
Pages (from-to)2514-2521
Number of pages8
JournalJournal of the American College of Cardiology
Volume61
Issue number25
DOIs
StatePublished - Jun 25 2013

Fingerprint

Aortic Valve Stenosis
Aortic Valve
Surgical Instruments
Longitudinal Studies
Echocardiography
Aortic Valve Insufficiency
Prostheses and Implants
Stroke Volume
Transcatheter Aortic Valve Replacement
Mitral Valve Insufficiency
Patient Selection

Keywords

  • aortic stenosis
  • echocardiography
  • surgical aortic valve replacement
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis : A longitudinal study of echocardiography parameters in cohort a of the PARTNER trial (Placement of aortic transcatheter valves). / Hahn, Rebecca T.; Pibarot, Philippe; Stewart, William J.; Weissman, Neil J.; Gopalakrishnan, Deepika; Keane, Martin G.; Anwaruddin, Saif; Wang, Zuyue; Bilsker, Martin S; Lindman, Brian R.; Herrmann, Howard C.; Kodali, Susheel K.; Makkar, Raj; Thourani, Vinod H.; Svensson, Lars G.; Akin, Jodi J.; Anderson, William N.; Leon, Martin B.; Douglas, Pamela S.

In: Journal of the American College of Cardiology, Vol. 61, No. 25, 25.06.2013, p. 2514-2521.

Research output: Contribution to journalArticle

Hahn, RT, Pibarot, P, Stewart, WJ, Weissman, NJ, Gopalakrishnan, D, Keane, MG, Anwaruddin, S, Wang, Z, Bilsker, MS, Lindman, BR, Herrmann, HC, Kodali, SK, Makkar, R, Thourani, VH, Svensson, LG, Akin, JJ, Anderson, WN, Leon, MB & Douglas, PS 2013, 'Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: A longitudinal study of echocardiography parameters in cohort a of the PARTNER trial (Placement of aortic transcatheter valves)', Journal of the American College of Cardiology, vol. 61, no. 25, pp. 2514-2521. https://doi.org/10.1016/j.jacc.2013.02.087
Hahn, Rebecca T. ; Pibarot, Philippe ; Stewart, William J. ; Weissman, Neil J. ; Gopalakrishnan, Deepika ; Keane, Martin G. ; Anwaruddin, Saif ; Wang, Zuyue ; Bilsker, Martin S ; Lindman, Brian R. ; Herrmann, Howard C. ; Kodali, Susheel K. ; Makkar, Raj ; Thourani, Vinod H. ; Svensson, Lars G. ; Akin, Jodi J. ; Anderson, William N. ; Leon, Martin B. ; Douglas, Pamela S. / Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis : A longitudinal study of echocardiography parameters in cohort a of the PARTNER trial (Placement of aortic transcatheter valves). In: Journal of the American College of Cardiology. 2013 ; Vol. 61, No. 25. pp. 2514-2521.
@article{525accc87a8e4886a41a0a804b35735f,
title = "Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: A longitudinal study of echocardiography parameters in cohort a of the PARTNER trial (Placement of aortic transcatheter valves)",
abstract = "Objectives This study sought to compare echocardiographic findings in patients with critical aortic stenosis following surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Background The PARTNER (Placement of Aortic Transcatheter Valves) trial randomized patients 1:1 to SAVR or TAVR. Methods Echocardiograms were obtained at baseline, discharge, 30 days, 6 months, 1 year, and 2 years after the procedure and analyzed in a core laboratory. For the analysis of post-implantation variables, the first interpretable study (≤6 months) was used. Results Both groups showed a decrease in aortic valve gradients and increase in effective orifice area (EOA) (p < 0.0001), which remained stable over 2 years. Compared with SAVR, TAVR resulted in larger indexed EOA (p = 0.038), less prosthesis-patient mismatch (p = 0.019), and more total and paravalvular aortic regurgitation (p < 0.0001). Baseline echocardiographic univariate predictors of death were lower peak transaortic gradient in TAVR patients, and low left ventricular diastolic volume, low stroke volume, and greater severity of mitral regurgitation in SAVR patients. Post-implantation echocardiographic univariate predictors of death were: larger left ventricular diastolic volume, left ventricular systolic volume and EOA, decreased ejection fraction, and greater aortic regurgitation in TAVR patients; and smaller left ventricular systolic and diastolic volumes, low stroke volume, smaller EOA, and prosthesis-patient mismatch in SAVR patients. Conclusions Patients randomized to either SAVR or TAVR experience enduring, significant reductions in transaortic gradients and increase in EOA. Compared with SAVR, TAVR patients had higher indexed EOA, lower prosthesis-patient mismatch, and more aortic regurgitation. Univariate predictors of death for the TAVR and SAVR groups differed and might allow future refinement in patient selection. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).",
keywords = "aortic stenosis, echocardiography, surgical aortic valve replacement, transcatheter aortic valve replacement",
author = "Hahn, {Rebecca T.} and Philippe Pibarot and Stewart, {William J.} and Weissman, {Neil J.} and Deepika Gopalakrishnan and Keane, {Martin G.} and Saif Anwaruddin and Zuyue Wang and Bilsker, {Martin S} and Lindman, {Brian R.} and Herrmann, {Howard C.} and Kodali, {Susheel K.} and Raj Makkar and Thourani, {Vinod H.} and Svensson, {Lars G.} and Akin, {Jodi J.} and Anderson, {William N.} and Leon, {Martin B.} and Douglas, {Pamela S.}",
year = "2013",
month = "6",
day = "25",
doi = "10.1016/j.jacc.2013.02.087",
language = "English",
volume = "61",
pages = "2514--2521",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "25",

}

TY - JOUR

T1 - Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis

T2 - A longitudinal study of echocardiography parameters in cohort a of the PARTNER trial (Placement of aortic transcatheter valves)

AU - Hahn, Rebecca T.

AU - Pibarot, Philippe

AU - Stewart, William J.

AU - Weissman, Neil J.

AU - Gopalakrishnan, Deepika

AU - Keane, Martin G.

AU - Anwaruddin, Saif

AU - Wang, Zuyue

AU - Bilsker, Martin S

AU - Lindman, Brian R.

AU - Herrmann, Howard C.

AU - Kodali, Susheel K.

AU - Makkar, Raj

AU - Thourani, Vinod H.

AU - Svensson, Lars G.

AU - Akin, Jodi J.

AU - Anderson, William N.

AU - Leon, Martin B.

AU - Douglas, Pamela S.

PY - 2013/6/25

Y1 - 2013/6/25

N2 - Objectives This study sought to compare echocardiographic findings in patients with critical aortic stenosis following surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Background The PARTNER (Placement of Aortic Transcatheter Valves) trial randomized patients 1:1 to SAVR or TAVR. Methods Echocardiograms were obtained at baseline, discharge, 30 days, 6 months, 1 year, and 2 years after the procedure and analyzed in a core laboratory. For the analysis of post-implantation variables, the first interpretable study (≤6 months) was used. Results Both groups showed a decrease in aortic valve gradients and increase in effective orifice area (EOA) (p < 0.0001), which remained stable over 2 years. Compared with SAVR, TAVR resulted in larger indexed EOA (p = 0.038), less prosthesis-patient mismatch (p = 0.019), and more total and paravalvular aortic regurgitation (p < 0.0001). Baseline echocardiographic univariate predictors of death were lower peak transaortic gradient in TAVR patients, and low left ventricular diastolic volume, low stroke volume, and greater severity of mitral regurgitation in SAVR patients. Post-implantation echocardiographic univariate predictors of death were: larger left ventricular diastolic volume, left ventricular systolic volume and EOA, decreased ejection fraction, and greater aortic regurgitation in TAVR patients; and smaller left ventricular systolic and diastolic volumes, low stroke volume, smaller EOA, and prosthesis-patient mismatch in SAVR patients. Conclusions Patients randomized to either SAVR or TAVR experience enduring, significant reductions in transaortic gradients and increase in EOA. Compared with SAVR, TAVR patients had higher indexed EOA, lower prosthesis-patient mismatch, and more aortic regurgitation. Univariate predictors of death for the TAVR and SAVR groups differed and might allow future refinement in patient selection. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).

AB - Objectives This study sought to compare echocardiographic findings in patients with critical aortic stenosis following surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Background The PARTNER (Placement of Aortic Transcatheter Valves) trial randomized patients 1:1 to SAVR or TAVR. Methods Echocardiograms were obtained at baseline, discharge, 30 days, 6 months, 1 year, and 2 years after the procedure and analyzed in a core laboratory. For the analysis of post-implantation variables, the first interpretable study (≤6 months) was used. Results Both groups showed a decrease in aortic valve gradients and increase in effective orifice area (EOA) (p < 0.0001), which remained stable over 2 years. Compared with SAVR, TAVR resulted in larger indexed EOA (p = 0.038), less prosthesis-patient mismatch (p = 0.019), and more total and paravalvular aortic regurgitation (p < 0.0001). Baseline echocardiographic univariate predictors of death were lower peak transaortic gradient in TAVR patients, and low left ventricular diastolic volume, low stroke volume, and greater severity of mitral regurgitation in SAVR patients. Post-implantation echocardiographic univariate predictors of death were: larger left ventricular diastolic volume, left ventricular systolic volume and EOA, decreased ejection fraction, and greater aortic regurgitation in TAVR patients; and smaller left ventricular systolic and diastolic volumes, low stroke volume, smaller EOA, and prosthesis-patient mismatch in SAVR patients. Conclusions Patients randomized to either SAVR or TAVR experience enduring, significant reductions in transaortic gradients and increase in EOA. Compared with SAVR, TAVR patients had higher indexed EOA, lower prosthesis-patient mismatch, and more aortic regurgitation. Univariate predictors of death for the TAVR and SAVR groups differed and might allow future refinement in patient selection. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).

KW - aortic stenosis

KW - echocardiography

KW - surgical aortic valve replacement

KW - transcatheter aortic valve replacement

UR - http://www.scopus.com/inward/record.url?scp=84879222556&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879222556&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2013.02.087

DO - 10.1016/j.jacc.2013.02.087

M3 - Article

C2 - 23623915

AN - SCOPUS:84879222556

VL - 61

SP - 2514

EP - 2521

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 25

ER -