Comprehensive Analysis of Mortality Among Patients Undergoing TAVR
Open accessAbstract
Background Patients with severe aortic stenosis (AS) who were deemed too high risk or inoperable for conventional aortic valve replacement (AVR) in the PARTNER (Placement of Aortic Transcatheter Valves) trial were randomized to transcatheter aortic valve replacement (TAVR) versus AVR (PARTNER-A arm) or standard therapy (PARTNER-B arm).Objectives This study compared when and how deaths occurred after TAVR versus surgical AVR or standard therapy.Methods The PARTNER-A arm included 244 transfemoral (TF) and 104 transapical (TA) TAVR patients, and 351 AVR patients; the PARTNER-B arm included 179 TF-TAVR patients and 179 standard therapy patients. Deaths were categorized as cardiovascular, noncardiovascular, or uncategorizable, and were characterized by multiphase hazard modelling.Results In the PARTNER-A arm, the risk of death peaked after randomization in the TA-TAVR and AVR groups, falling to low levels commensurate with the U.S. population within 3 months. Early risk was less in TF-TAVR patients, resulting in initial superior survival; between 12 and 18 months, risk increased, such that within 2 years, TF-TAVR and AVR patients had similar survival rates. Cardiovascular, noncardiovascular, and uncategorizable deaths for TF-TAVR were 37%, 43%, and 20%, respectively, versus 22%, 41%, and 37%, respectively, for TA-TAVR and 33%, 43%, and 24%, respectively, for AVR. In the PARTNER-B arm, risk with standard therapy was 60% per year; TF-TAVR reduced risk to 20% per year, resulting in 0.5 years of life added within 2.5 years.Conclusions In inoperable AS patients, TAVR substantially reduced the risk of cardiovascular death. In high-risk patients, TA-TAVR and AVR were associated with elevated peri-procedural risk more than with TF-TAVR, although cardiovascular death was higher after TF-TAVR. Therefore, TF-TAVR should be considered the standard of care for severely symptomatic inoperable patients or those at high risk of noncardiovascular mortality after conventional surgery. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).
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When cause of death was difficult to categorize, it often occurred in frail patients who were failing to thrive.
“Moreover, when cause of death was difficult to categorize, it often occurred in frail patients who were failing to thrive246.”
From Calcific aortic stenosis (2016) · cites this paper as [246]
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Causes and temporal trends in procedural deaths after transcatheter aortic valve implantation
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Late survival and heart failure after transcatheter aortic valve implantation
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Predicting hospitalisation duration after transcatheter aortic valve implantation
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Updates on transcatheter aortic valve replacement: Techniques, complications, outcome, and prognosis
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Transcarotid Transcatheter Aortic Valve Replacement
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Prognostic Impact of Psoas Muscle Mass Index following Trans-Catheter Aortic Valve Replacement
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“Silent” Acute Native Valve Leaflet Avulsion during Transcatheter Aortic Valve Replacement
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New Transcatheter Aortic Valve Prosthesis Sets a New Standard
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Self-citationMortality in the PARTNER Trials
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Transcatheter Mitral Valve Replacement Clears the First Hurdle ∗
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Indicaciones del TAVI. ¿En qué se basan?
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In the Garden of Forking Paths: Choosing Between Alternative Access for TAVR
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Human Epididymis Protein 4 in Transcatheter Aortic Valve Implantation
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Transfemoral transcatheter aortic valve replacement in the presence of a mitral prosthesis
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Myocardial functional changes in transfemoral versus transapical aortic valve replacement
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Insights from a multidisciplinary heart team for highest-risk valve disease
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Transcatheter Aortic Valve Replacement in Moderate-risk Aortic Stenosis Patients
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Indications and Utility of Percutaneous Balloon Aortic Valvuloplasty in Older Adults
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Self-citationCreating a new and simply frailty score for predicting postoperative morbidity in cardiac surgery
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Editor-in-Chief's Picks From 2014: Part One
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Why a new structural and endovascular Journal of Thoracic and Cardiovascular Surgery journal?
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- Authors
- Svensson, L. G., Blackstone, E. H., Rajeswaran, J., Brozzi, N., Leon, M. B., Smith, C. R., Mack, M., Miller, D. C., Moses, J. W., Tuzcu, E. M., Webb, J. G., Kapadia, S., Fontana, G. P., Makkar, R. R., Brown, D. L., Block, P. C., Guyton, R. A., Thourani, V. H., Pichard, A. D., Bavaria, J. E., Herrmann, H. C., Williams, M. R., Babaliaros, V., Généreux, P., & Akin, J. J.
- Affiliations
- Cleveland Clinic (US)
- NewYork–Presbyterian Hospital (US)
- Baylor Scott & White Health (US)
- Stanford Medicine (US)
- University of British Columbia (CA)
- Cedars-Sinai Medical Center (US)
- Emory University (US)
- MedStar Washington Hospital Center (US)
- Hospital of the University of Pennsylvania (US)
- Edwards Lifesciences (United States) (US)
- Corresponding author
- Svensson, Lars G.
- ORCID
- Svensson, Lars G.
- Blackstone, Eugene H.
- Rajeswaran, Jeevanantham
- Leon, Martin B.
- Smith, Craig R.
- Mack, Michael
- Miller, D. Craig
- Moses, Jeffrey W.
- Tuzcu, E. Murat
- Webb, John G.
- Kapadia, Samir
- Fontana, Gregory P.
- Makkar, Raj R.
- Brown, David L.
- Block, Peter C.
- Guyton, Robert A.
- Thourani, Vinod H.
- Bavaria, Joseph E.
- Herrmann, Howard C.
- Williams, Mathew R.
- Babaliaros, Vasilis
- Généreux, Philippe
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2014-07
- Volume
- 64
- Issue
- 2
- Pages
- 158-168
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W154700364
- Cited by
- 88
- References
- 32
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 6 · 2022: 4 · 2021: 6 · 2020: 5 · 2019: 5 · 2018: 4 · 2017: 13 · 2016: 18 · 2015: 15 · 2014: 4
- FWCI
- 11.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Edwards Lifesciences
- Boston Scientific Corporation
- St. Jude Medical
- Abbott Vascular
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Keywords
- transcatheter aortic valve implantation, severe aortic stenosis, mortality, cardiovascular mortality, transfemoral access, transapical approach, surgical aortic valve replacement, PARTNER trial, inoperable patients, high-risk patients, survival analysis, standard therapy comparison, timing of death
- MeSH terms
- Aged, Aortic Valve Stenosis, Cause of Death, Female, Follow-Up Studies, Cardiac Catheterization, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Severity of Illness Index, Time Factors, United States, Survival Rate, Treatment Outcome, Risk Assessment, Heart Valve Prosthesis Implantation
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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