Transcatheter aortic valve replacement in low risk patients: a review of PARTNER 3 and Evolut low risk trials
| Autor: | Tanira Ferreira, Kunal Kapoor, Mauricio G. Cohen, Torin P Thielhelm, Joao Braghiroli |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Framingham Risk Score business.industry medicine.medical_treatment Hazard ratio Review Article 030204 cardiovascular system & hematology medicine.disease Confidence interval Surgery 03 medical and health sciences Stenosis 0302 clinical medicine Valve replacement Aortic valve replacement Clinical endpoint medicine 030212 general & internal medicine Cardiology and Cardiovascular Medicine business Stroke |
| Popis: | Transcatheter aortic valve replacement (TAVR) has become a mainstay in treatment for patients with severe aortic stenosis who are considered high-risk surgical candidates. The use of TAVR in low-risk patients with severe aortic stenosis is being explored as an alternative to surgical aortic valve replacement (SAVR). Recent results from the Medtronic Evolut Low Risk trial and the Placement of Aortic Transcatheter Valves (PARTNER) 3 trial shed light on the use of TAVR in low-risk surgical candidates. The Evolut Low Risk trial compared TAVR with a self-expanding supra-annular bioprosthesis to SAVR in 1468 patients with severe aortic stenosis who were low surgical risk. Patients with a mean age of 74 and a mean Society of Thoracic Surgeons (STS) risk score of 1.9% were randomized to either TAVR or SAVR groups. Using the composite end point of death or disabling stroke at 24 months, the study found an incidence of 5.3% in the TAVR arm and 6.7% in the surgical arm. The Evolut Low Risk trial thus concluded that TAVR was statistically noninferior but not superior to SAVR (difference, −1.4 percentage points; 95% Bayesian credible interval for the difference, −4.9 to 2.1; posterior probability of noninferiority, >0.999). The PARTNER 3 trial assigned 1,000 patients with severe aortic stenosis and low surgical risk to either TAVR with transfemoral placement of balloon expandable valve or SAVR. Patients with a mean age of 73 and a mean STS score of 1.9% were randomized to either TAVR or SAVR groups. With respect to the primary endpoint of composite death from any cause, stroke, or rehospitalization, the study found an occurrence of 8.5% in TAVR and 15.1% in SAVR, confirming both noninferiority and superiority in the TAVR group [absolute difference, −6.6 percentage points; 95% confidence interval (CI), −10.8 to −2.5; P |
| Databáze: | OpenAIRE |
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