Two-year outcomes from the PARTNER 3 trial: where do we stand?

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Heart Valve Disease

Background:

• Aortic stenosis (AS) is a significant cause of morbidity and mortality.
• Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement (SAVR).
• The PARTNER 3 trial initially assessed TAVR versus SAVR in low-risk patients.

Purpose of the Study:

• To compare outcomes between TAVR and SAVR in low-risk patients with AS.
• To address recent concerns regarding the long-term durability of TAVR devices.
• To provide recommendations for TAVR and SAVR in AS management.

Main Methods:

• The PARTNER 3 randomized controlled trial.
• Comparison of a balloon-expandable TAVR valve versus SAVR.
• Assessment of composite endpoints including death, stroke, and rehospitalization at 1 and 2 years.

Main Results:

• TAVR demonstrated initial superiority over SAVR at 1 year.
• At 2 years, TAVR was found to be noninferior to SAVR.
• Recent concerns regarding valve thrombosis and longevity in the TAVR arm require further investigation.

Conclusions:

• TAVR is a viable and noninferior alternative to SAVR for low-risk patients with AS up to 2 years post-procedure.
• Ongoing monitoring and longer-term data are crucial to fully evaluate TAVR device durability and address emerging concerns.
• Understanding these findings is essential for Heart Teams in guiding patient selection and treatment strategies.