Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients - Université Paris-Est-Créteil-Val-de-Marne Access content directly
Journal Articles Circulation Year : 2020

Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients

Philippe Pibarot
Erwan Salaun
  • Function : Author
Abdellaziz Dahou
  • Function : Author
Eleonora Avenatti
  • Function : Author
Ezequiel Guzzetti
  • Function : Author
Mohamed-Salah Annabi
  • Function : Author
Oumhani Toubal
  • Function : Author
Mathieu Bernier
  • Function : Author
Jonathan Beaudoin
  • Function : Author
Géraldine Ong
  • Function : Author
Laura Krapf
  • Function : Author
Vinod Thourani
  • Function : Author
Raj Makkar
  • Function : Author
Susheel Kodali
  • Function : Author
Mark Russo
  • Function : Author
Samir Kapadia
  • Function : Author
S. Chris Malaisrie
  • Function : Author
David Cohen
  • Function : Author
Jonathon Leipsic
  • Function : Author
Philipp Blanke
  • Function : Author
Mathew Williams
  • Function : Author
James Mccabe
  • Function : Author
David Brown
  • Function : Author
Vasilis Babaliaros
  • Function : Author
Scott Goldman
  • Function : Author
Wilson Szeto
  • Function : Author
Philippe Généreux
  • Function : Author
Ashish Pershad
  • Function : Author
Maria Alu
  • Function : Author
Ke Xu
  • Function : Author
Erin Rogers
  • Function : Author
John Webb
  • Function : Author
Craig Smith
  • Function : Author
Michael Mack
  • Function : Author
Martin Leon
  • Function : Author
Rebecca Hahn
  • Function : Author

Abstract

Background: This study aimed to compare echocardiographic findings in low-risk patients with severe aortic stenosis after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Methods: The PARTNER 3 trial (Placement of Aortic Transcatheter Valves) randomized 1000 patients with severe aortic stenosis and low surgical risk to undergo either transfemoral TAVR with the balloon-expandable SAPIEN 3 valve or SAVR. Transthoracic echocardiograms obtained at baseline and at 30 days and 1 year after the procedure were analyzed by a consortium of 2 echocardiography core laboratories. Results: The percentage of moderate or severe aortic regurgitation (AR) was low and not statistically different between the TAVR and SAVR groups at 30 days (0.8% versus 0.2%; P =0.38). Mild AR was more frequent after TAVR than SAVR at 30 days (28.8% versus 4.2%; P <0.001). At 1 year, mean transvalvular gradient (13.7±5.6 versus 11.6±5.0 mm Hg; P =0.12) and aortic valve area (1.72±0.37 versus 1.76±0.42 cm 2 ; P =0.12) were similar in TAVR and SAVR. The percentage of severe prosthesis–patient mismatch at 30 days was low and similar between TAVR and SAVR (4.6 versus 6.3%; P =0.30). Valvulo-arterial impedance (Z va ), which reflects total left ventricular hemodynamic burden, was lower with TAVR than SAVR at 1 year (3.7±0.8 versus 3.9±0.9 mm Hg/mL/m 2 ; P <0.001). Tricuspid annulus plane systolic excursion decreased and the percentage of moderate or severe tricuspid regurgitation increased from baseline to 1 year in SAVR but remained unchanged in TAVR. Irrespective of treatment arm, high Z va and low tricuspid annulus plane systolic excursion, but not moderate to severe AR or severe prosthesis–patient mismatch, were associated with increased risk of the composite end point of mortality, stroke, and rehospitalization at 1 year. Conclusions: In patients with severe aortic stenosis and low surgical risk, TAVR with the SAPIEN 3 valve was associated with similar percentage of moderate or severe AR compared with SAVR but higher percentage of mild AR. Transprosthetic gradients, valve areas, percentage of severe prosthesis–patient mismatch, and left ventricular mass regression were similar in TAVR and SAVR. SAVR was associated with significant deterioration of right ventricular systolic function and greater tricuspid regurgitation, which persisted at 1 year. High Z va and low tricuspid annulus plane systolic excursion were associated with worse outcome at 1 year whereas AR and severe prosthesis–patient mismatch were not. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02675114.

Dates and versions

hal-04395014 , version 1 (15-01-2024)

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Philippe Pibarot, Erwan Salaun, Abdellaziz Dahou, Eleonora Avenatti, Ezequiel Guzzetti, et al.. Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients. Circulation, 2020, 141 (19), pp.1527-1537. ⟨10.1161/CIRCULATIONAHA.119.044574⟩. ⟨hal-04395014⟩

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