Five-Year Outcomes with Transcatheter Aortic-Valve Replacement

van Belle, Eric; Labreuche, Julien; Vincent, Flavien

Type de document :

Article dans une revue scientifique: Article original

DOI :

10.1056/NEJMc2018853

Titre :

Five-Year Outcomes with Transcatheter Aortic-Valve Replacement

Auteur(s) :

van Belle, Eric [Auteur]
Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U 1011 [RNMCD]
Institut Coeur Poumon [CHU Lille]
Labreuche, Julien [Auteur]
Vincent, Flavien [Auteur]

Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U 1011 [RNMCD]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]

Titre de la revue :

New England Journal of Medicine

Pagination :

594-596

Éditeur :

Massachusetts Medical Society

Date de publication :

2020-08-06

ISSN :

0028-4793

Discipline(s) HAL :

Sciences du Vivant [q-bio]

Résumé en anglais : [en]

The editorialist and colleagues reply: We thank Barili et al. for their methodologic point regarding the trial by Makkar et al. reporting the 5-year outcomes of the comparison of surgical aortic-valve replacement versus ...
Lire la suite >The editorialist and colleagues reply: We thank Barili et al. for their methodologic point regarding the trial by Makkar et al. reporting the 5-year outcomes of the comparison of surgical aortic-valve replacement versus TAVR with the SAPIEN XT valve (PARTNER 2 cohort A trial). They noted that the proportional-hazards assumption was not verified over time, as easily spotted by the crossing of the Kaplan-Meier curves after 2 years of follow-up. Makkar et al. anticipated this possibility and prespecified the calculation of the restricted mean survival time and the restricted mean event-free time for the primary end point (death or disabling stroke). 1 These results, which are reported in Table S8 and in the text, show that the 5-year restricted mean survival time was similar for TAVR and surgery (46.3 months and 46.6 months, respectively), as was the restricted mean event-free time for the end point of death or disabling stroke (45.0 months and 44.8 months). They also performed a landmark analysis showing superiority of surgery beyond 2 years (hazard ratio with TAVR, 1.27; 95% CI, 1.06 to 1.53) (Table S7). The potential explanations for this late increase in risk with TAVR were extensively discussed in the editorial, including the potential role of paravalvular regurgitation, the lack of concomitant coronary or valve procedures, and durability concerns. Khokhar et al. commented that the magnitude of the left ventricular mass regression was less pronounced in the TAVR group than in the surgery group. We can reasonably speculate that the higher rate of mild or greater paravalvular regurgitation with the second-generation transcatheter bioprosthesis than with the surgical valve may have adversely influenced left ventricle remodeling. 2 The recently published echocardiographic outcomes of low-risk patients in the PARTNER 3 trial are supportive of this hypothesis, since the very low rate of aortic regurgitation that was achieved with the third-generation valve (SAPIEN 3) was associated with left ventricular mass regression similar to that with surgery at 1 year (-11.9±21.10 vs.-12.0±27.09 g per square meter, P=0.84).Lire moins >

Langue :

Anglais

Comité de lecture :

Oui

Audience :

Internationale

Vulgarisation :

Non

Collections :

Récepteurs nucléaires, Maladies Cardiovasculaires et Diabète (RNMCD) - U1011

Source :

Harvested from HAL

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