Background: Surgery remains an important treatment for low-risk patients with severe symptomatic aortic stenosis (AS). We evaluated 5-year outcomes in low-risk patients undergoing isolated surgical aortic valve replacement (SAVR) or SAVR with concomitant procedures within the randomized PARTNER 3 trial.
Methods: In the PARTNER 3 trial, 454 patients underwent surgery for severe, symptomatic, tri-leaflet AS and were followed for 5 years. Patients were stratified into those undergoing isolated SAVR (n=334, 73.6%) versus concomitant SAVR (n=120, 26.4%). Short- and long-term morbidity was adjudicated by a Clinical Events Committee. Hemodynamic valve performance was evaluated by an echocardiographic core laboratory. Patient-reported health status was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ).
Results: The mean age was 73.6±6.1 years; 71.1% were male. The median SAVR implant size was 23mm overall. Five-year all-cause mortality (with vital status sweep) was 9.0% for all patients (8.5% isolated, 10.2% concomitant SAVR, p=0.58); rates that were comparable to a recent analysis of low-risk isolated SAVR patients in the STS database (overall mortality 7.1%). The average 5-year mean gradient was 11.7±5.6 mmHg overall. Reintervention rates were low in both groups (isolated SAVR 2.3% versus concomitant SAVR 5.0%, p=0.21), and the majority of patients (isolated SAVR 87.9%; concomitant SAVR 86.1%) were alive with no evidence of bioprosthetic valve failure at 5 years.
Conclusions: SAVR in low-risk patients in the PARTNER 3 trial demonstrated excellent 5-year outcomes. Five-year mortality was similar in patients undergoing isolated versus concomitant SAVR. This was comparable to recently published national SAVR outcomes, demonstrating the generalizability of these findings.
Keywords: Aortic Valve; PARTNER 3; SAVR; outcomes.
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