TAVR vs. open surgery for aortic stenosis: The results are in

February 27, 2020

The five-year outcomes of the PARTNER 2 study were published in the New England Journal of Medicine today, 27 February 2020. After enrolling over 2000 intermediate risk patients with severe aortic stenosis and randomizing them to TAVR or open surgical aortic valve replacement, there were no significant differences in the primary endpoint of death or disabling stroke through 5 years.

An examination of the Kaplan-Meier curves for the primary endpoint is instructive and particularly informative when considered in the context of the average age at enrollment of almost 82 years. The curves depict a greater risk for death or stroke for open surgery, at least numerically, through the first three years following treatment. The curves cross at that point and the risk for surgery is lower than for TAVR.

Although the differences were not statistically significant, the early benefit of TAVR over surgery is important when one considers the age of the patients. To a nonagenarian, the first few years after treatment are probably the most important. Activity levels wain quickly in the very elderly and late benefit may be less important to a patient than what happens early on.

The PARTNER 2 study raises the specter of whether a benefit of TAVR over open surgery may be more than the final numbers suggest. As always, the decisions must be individualized for each patient, but the overall comparative outcomes are enlightening.

Makkar RR, Thourani VH, Mack MJ, Kodali SK, Kapadia S, Webb JG, et al., for the PARTNER 2 Investigators. N Engl J Med 2020;382:799-809