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HOUSTON -- Detailed analysis of the intermediate surgical risk cohort of the PARTNER 2 trial turned up better than expected survival after surgical aortic valve replacement (SAVR), researchers reported here.
The all-cause 30-day operative mortality rate of 4.1% was a relative 22% lower than the expected 5.8% rate predicted by STS surgical risk score, , of Emory University in Atlanta, reported at the Society of Thoracic Surgeons annual meeting.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Renal failure requiring dialysis was also 56% lower than expected among these 937 intermediate-risk patients who got SAVR as part of the PARTNER 2A trial, whereas deep sternal wound infections were about twice expected.
Although the 5.4% in-hospital stroke rate was twice what was predicted, that was likely the effect of looking harder, Thourani suggested, because the trial prespecified neurologic assessment for all patients postoperatively.
The overall 2-year results showing noninferiority between surgical and transcatheter approaches for intermediate-risk patients were published last year in the New England Journal of Medicine, which many considered a win for the less invasive approach.
But, "the bottom line is patients who end up with SAVR can expect great results," said , of the University of Southern California in Los Angeles, as moderator of a press conference.
Thourani agreed calling the results "excellent," and noted that surgery does still hold the advantage of more long-term data showing very little degradation and less paravalvular leakage.
Beyond surgical risk score alone, age matters in these decisions too, noted Cohen. "We need to flesh out the data a little more specifically, rather than just rely on percentile STS to answer some of these questions."
Other findings of note in the analysis included that, among the about 80% of patients with isolated AVR, minimally invasive AVR did not result in increased mortality or more strokes compared to full sternotomy.
Also, the one-third of patients who had severe prosthesis-patient mismatch, had similar survival to those without severe mismatch.
Disclosures
The PARTNER 2 trial was supported by Edwards Lifesciences.
Thourani disclosed relevant relationships with Edwards Lifesciences.
Primary Source
Society of Thoracic Surgeons
Thourani V, et al "Clinical and echocardiographic outcomes in 937 intermediate-risk patients undergoing surgical aortic valve replacement in PARTNER 2A" STS 2017.