Three-Year Outcomes Following TAVR in Younger (<75 Years) Low-Surgical-Risk Severe Aortic Stenosis Patients.

aortic valve stenosis humans incidence stroke transcatheter aortic valve replacement

Journal

Circulation. Cardiovascular interventions
ISSN: 1941-7632
Titre abrégé: Circ Cardiovasc Interv
Pays: United States
ID NLM: 101499602

Informations de publication

Date de publication:
18 Oct 2024
Historique:
medline: 18 10 2024
pubmed: 18 10 2024
entrez: 18 10 2024
Statut: aheadofprint

Résumé

Transcatheter aortic valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis, but data are limited on younger, low-risk patients. This analysis compares outcomes in low-surgical-risk patients aged <75 years receiving TAVR versus surgery. The Evolut Low Risk Trial randomized 1414 low-risk patients to treatment with a supra-annular, self-expanding TAVR or surgery. We compared rates of all-cause mortality or disabling stroke, associated clinical outcomes, and bioprosthetic valve performance at 3 years between TAVR and surgery patients aged <75 years. In patients <75 years, 352 were randomized to TAVR and 351 to surgery. Mean age was 69.1±4.0 years (minimum 51 and maximum 74); Society of Thoracic Surgeons Predicted Risk of Mortality was 1.7±0.6%. At 3 years, all-cause mortality or disabling stroke for TAVR was 5.7% and 8.0% for surgery ( Low-risk patients <75 years treated with supra-annular, self-expanding TAVR had comparable 3-year all-cause mortality and lower disabling stroke compared with patients treated with surgery. There was significantly better valve performance in patients treated with TAVR. URL: https://clinicaltrials.gov; Unique identifier: NCT02701283.

Sections du résumé

BACKGROUND UNASSIGNED
Transcatheter aortic valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis, but data are limited on younger, low-risk patients. This analysis compares outcomes in low-surgical-risk patients aged <75 years receiving TAVR versus surgery.
METHODS UNASSIGNED
The Evolut Low Risk Trial randomized 1414 low-risk patients to treatment with a supra-annular, self-expanding TAVR or surgery. We compared rates of all-cause mortality or disabling stroke, associated clinical outcomes, and bioprosthetic valve performance at 3 years between TAVR and surgery patients aged <75 years.
RESULTS UNASSIGNED
In patients <75 years, 352 were randomized to TAVR and 351 to surgery. Mean age was 69.1±4.0 years (minimum 51 and maximum 74); Society of Thoracic Surgeons Predicted Risk of Mortality was 1.7±0.6%. At 3 years, all-cause mortality or disabling stroke for TAVR was 5.7% and 8.0% for surgery (
CONCLUSIONS UNASSIGNED
Low-risk patients <75 years treated with supra-annular, self-expanding TAVR had comparable 3-year all-cause mortality and lower disabling stroke compared with patients treated with surgery. There was significantly better valve performance in patients treated with TAVR.
REGISTRATION UNASSIGNED
URL: https://clinicaltrials.gov; Unique identifier: NCT02701283.

Identifiants

pubmed: 39421943
doi: 10.1161/CIRCINTERVENTIONS.124.014018
doi:

Banques de données

ClinicalTrials.gov
['NCT02701283']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e014018

Auteurs

Thomas Modine (T)

Centre Hospitalier Universitaire de Bordeaux, L'Unité Médico-Chirurgicale des Valvulopathies, Chirurgie Cardiaque, Université de Bordeaux, France (T.M.).

Didier Tchétché (D)

Clinique Pasteur, Toulouse, France (D.T., P.B.).

Nicolas M Van Mieghem (NM)

Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, the Netherlands (N.M.V.M., R.A.).

G Michael Deeb (GM)

Department of Cardiac Surgery and Division of Interventional Cardiology, Michigan Medicine Health Systems - University Hospital, Ann Arbor, MI. (G.M.D.).

Stanley J Chetcuti (SJ)

Department of Internal Medicine and Division of Cardiovascular Medicine, Michigan Medicine Health Systems - University Hospital, Ann Arbor, MI. (S.J.C.).

Steven J Yakubov (SJ)

Department of Cardiology, Ohio Health Riverside Methodist Hospital, Columbus (S.J.Y.).

Paul Sorajja (P)

Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (P.S.).

Hemal Gada (H)

Department of Interventional Cardiology and Cardiothoracic Surgery, University of Pittsburgh Medical Center, Moffitt Heart/Pinnacle Health, Harrisburg, PA (H.G., M.M.).

Mubashir Mumtaz (M)

Department of Interventional Cardiology and Cardiothoracic Surgery, University of Pittsburgh Medical Center, Moffitt Heart/Pinnacle Health, Harrisburg, PA (H.G., M.M.).

Basel Ramlawi (B)

Cardiothoracic Surgery, Lankenau Heart Institute, Wynnewood, PA (B.R.).

Tanvir Bajwa (T)

Department of Interventional Cardiology and Cardiothoracic Surgery, Aurora Health Care, Aurora St. Luke's Medical Center, Milwaukee, WI (T.B., J.C.).

John Crouch (J)

Department of Interventional Cardiology and Cardiothoracic Surgery, Aurora Health Care, Aurora St. Luke's Medical Center, Milwaukee, WI (T.B., J.C.).

Paul S Teirstein (PS)

Department of Interventional Cardiology, Scripps Clinic, Scripps Prebys Cardiovascular Institute, La Jolla, CA (P.S.T.).

Neal S Kleiman (NS)

Department of Interventional Cardiology and Cardiothoracic Surgery, Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K., M.J.R.).

Ayman Iskander (A)

Saint Joseph's Hospital Health Center, Syracuse, NY (A.I.).

Rodrigo Bagur (R)

London Health Sciences Centre - University Campus, Ontario, Canada (R.B., M.W.A.C.).

Michael W A Chu (MWA)

London Health Sciences Centre - University Campus, Ontario, Canada (R.B., M.W.A.C.).

Pierre Berthoumieu (P)

Clinique Pasteur, Toulouse, France (D.T., P.B.).

Arnaud Sudre (A)

Centre Hospitalier Régional Universitaire de Lille, France (A.S.).

Rik Adrichem (R)

Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, the Netherlands (N.M.V.M., R.A.).

Saki Ito (S)

Echocardiography Core Laboratory, Mayo Clinic, Rochester, MN (S.I.).

Jian Huang (J)

Medtronic, Mounds View, MN (J.H., J.J.P.).

Jeffrey J Popma (JJ)

Medtronic, Mounds View, MN (J.H., J.J.P.).

John K Forrest (JK)

Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, CT (J.K.F.).

Michael J Reardon (MJ)

Department of Interventional Cardiology and Cardiothoracic Surgery, Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K., M.J.R.).

Classifications MeSH