Can we still learn from single center experience after PARTNER?

With the publication of the Placement of Aortic Transcatheter Valves (PARTNER) trial, transcatheter aortic valve replacement (TAVR) has undoubtedly become the gold standard for severe aortic stenosis in patients that are not suitable candidate for surgical aortic valve replacement (AVR). The PARTNER trial also showed that TAVR is non-inferior to AVR in high-risk patients. A recent publication by Ben-Dor et al evaluated the outcome of high-risk patients with severe aortic stenosis who were referred to their institution for participation to the PARTNER trial. Only a minority of patients made it in the trial and the majority of patient ended being treated medically. Some patients were also treated with AVR outside the trial. The outcomes of all these patients were stratified by the treatment they received (AVR, TAVR or medical therapy with or without balloon aortic valvuloplasty). The 3 groups were different in their baseline characteristics. Ben-Dor et al found that patients treated medically had greater mortality than patients treated with TAVR or AVR. The survival of patients treated with TAVR was similar to those treated with AVR. Independent predictors of mortality were also found from their analysis. In this commentary, we discuss the finding of this study and compare it with the current literature.