Surgery for Aortic Stenosis: PARTNER Trial Update
Results from PARTNER trial Cohort B show that patients with severe aortic stenosis who are unable to undergo traditional surgery for technical reasons fared better with transcatheter aortic valve replacement (TAVR) than patients who were just too sick to undergo valve surgery.
Approximately 300,000 Americans have aortic stenosis, or narrowing of the aortic valve in the heart. Until recently, treatment options included medical therapy and surgery to replace the valve through a traditional open heart approach. In contrast to traditional surgery, TAVR entails replacing the valve by using a catheter that is advanced into the heart through a small incision in the groin. Craig R. Smith, MD, Chair, Department of Surgery, is Principal Investigator of the 26-center PARTNER trial, which began in 2007 and is considered one of the most important studies of this therapy. Co-Principal Investigators include Susheel Kodali, MD, Co-directors of the Heart Valve Center at NewYork-Presbyterian/Columbia University Medical Center.
TAVR provides an important therapeutic option for patients who are ineligible for surgery for technical reasons such as heavy calcification of the aorta, chest wall deformity, prior radiation to the chest, or potential damage to previous bypass graft. Patients may also be ineligible for surgery because they are simply too sick or frail to withstand open heart surgery.
In an article published in NewsDaily.com, Dr. Ajay Kirtane, an interventional cardiologist at NewYork-Presbyterian/Columbia, explains, “We often struggle to determine which patients to treat with TAVR, and to identify which patients might not do as well.” He says that the results published October 23, 2013 in the Journal of the American College of Cardiology show that “Although there were many reasons for inoperability, patients with technical issues for inoperability that would render surgical AVR more complex or difficult fared better overall with TAVR than did patients who in some respects were just too sick for surgical aortic valve replacement.”
So far, the PARTNER trial has also found that patients undergoing TAVR have the same one-year survival rates as high-risk patients who undergo surgical valve replacement. Two-year survival rates also confirmed TAVR’s efficacy in patients who were high risk for surgery. As defined in the trial, “high risk” comprises 5-15% of the total population undergoing surgical aortic valve replacement.