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April 10, 2020

One-Year Echocardiographic Results From the PARTNER 3 Trial Published

April 10, 2020—Online in Circulation, Philippe Pibarot, DVM, et al published echocardiographic results from the PARTNER 3 trial of transcatheter aortic valve replacement (TAVR) using the balloon-expandable Sapien 3 valve (Edwards Lifesciences). PARTNER 3 randomized 1,000 patients with severe, symptomatic aortic stenosis who were at low surgical risk to undergo either transfemoral TAVR with the Sapien 3 valve or surgical aortic valve replacement (SAVR).

Transthoracic echocardiograms were obtained at baseline, at 30 days, and at 1-year postprocedure and were analyzed by a consortium of two echocardiography core laboratories.

As summarized in Circulation, the investigators reported the following echocardiographic findings for TAVR patients versus SAVR patients:

  • At 30 days, the percentage of moderate/severe aortic regurgitation (AR) was low and not statistically different (0.8% vs 0.2%; P = .38)
  • At 30 days, mild AR was more frequent after TAVR (28.8% vs 4.2%; P < .001)
  • At 30 days, the percentage of severe prosthesis-patient mismatch (PPM) was low and similar (4.6% vs 6.3%; P = .3)
  • At 1 year, mean transvalvular gradient was similar (13.7 ± 5.6 vs 11.6 ± 5 mm Hg; P = .12)
  • At 1 year, aortic valve area was similar (1.72 ± 0.37 vs 1.76 ± 0.42 cm2; P = .12)
  • At 1 year, valvulo-arterial impedance (Zva), which reflects total left ventricular hemodynamic burden, was lower with TAVR (3.7 ± 0.8 vs 3.9 ± 0.9 mm Hg/mL/m2; P < .001)
  • From baseline to 1 year, tricuspid annulus plane systolic excursion (TAPSE) decreased, and the percentage of moderate/severe tricuspid regurgitation increased in SAVR, whereas they remained unchanged in TAVR
  • At 1 year, high Zva and low TAPSE—but not moderate/severe AR or severe PPM—were associated with increased risk of the composite endpoint of mortality, stroke, and hospitalization, irrespective of the treatment arm

In 2019, the 1-year findings from the PARTNER 3 trial were published by Michael J. Mack, MD, et al in The New England Journal of Medicine (2019;380:1695–1705).

On March 29, 2020, Dr. Mack presented 2-year clinical and echocardiographic outcomes from the PARTNER 3 study at the ACC.20/WCC Virtual conference of the American College of Cardiology’s Annual Scientific Session Together with World Congress of Cardiology.

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