Five-Year Outcomes with Transcatheter Aortic-Valve Replacement

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

Document type :

Article dans une revue scientifique: Article original

DOI :

10.1056/NEJMc2018853

Title :

Five-Year Outcomes with Transcatheter Aortic-Valve Replacement

Author(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]

Journal title :

New England Journal of Medicine

Pages :

594-596

Publisher :

Massachusetts Medical Society

Publication date :

2020-08-06

ISSN :

0028-4793

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [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 ...
Show more >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).Show less >

Language :

Anglais

Peer reviewed article :

Oui

Audience :

Internationale

Popular science :

Non

Collections :

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

Source :

Harvested from HAL

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