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Partner B cohort: Comparison of outcomes of TAVI vs standard therapy in patients with AS unsuitable for surgery 699 patients

At 1 year decreased all cause mortality (30.7% vs 50.7%) decreased composite of death from any cause or repeat hospitalization (42.5% vs 71.6%) decreased NYHA III/IV in survivors (25.2% vs 58%) At 30 days increased risk of stroke (5.0% vs 1.1 %) increased risk of major vascular complications (16.2% vs 1.1%)


Department of Veterans Affair

575 men who underwent valve replacement (384 aortic, and 181 mitral) between 1987 to 1992 with a 15 year follow up. Patients who underwent mechanical AVR (Bjok-shiley) had a better long term survival than those who underwent bioprosthetic AVR (Hancock). In younger patients aged less than 65 years old SVD occurred approximately 7-8 years following bioprosthetic AVR


Edinburgh Heart valve

541 men and women who underwent valve replacement (211 aortic and 261 mitral) between 1975 and 1979 with a 20 year follow-up. There was no survival difference between patients who underwent mechanical AVR (Bjork-Shiley) and bioprosthetic AVR (Hancock/Carpentier Edwards porcine). Re-operation rates were greater then bioprosthetic AVR than mechanical AVR


Risk of late aortic events after an isolated aortic valve replacement for bicuspid arortic valve stenosis with concomitant ascending aortic dilation Evaldas, (Borger) EJCTS 2012;42(5) 832:838

Instiutional database of 153 BAV with stenosis and concomitant ascending aortic dilation of 40 to 50mm who underwent isolated AVR from 1995 to 2000. mean age was 54 Follow-up was 100% complete. Mean follow-up was 11.5years +/- 3.2 years. Survival rates of 86 and 78% at 10 and 15 years. Ascending aortic surgery was required in 5 patients (For progressive aortic aneurysm). Freedom from aortic interventions at 10 and 15 years was 97 and 94% for the AS group (slightly lower for the AI group 88 and 70% at 10 and 15 years). Suggest that BAV with AS and mild to moderate ascending dilation are at considerable low risk for adverse events at 15 years. BAV phenotype should be considered.


Effect of Proshesis-patient mismatch on long-term survival with aortic valve replacement: assessment to 15 year Jamieson WR, Ye J, Higgins J, Cheung A, etc..Lichtenstein SV Annals of thoracic surgery 2010 Jan;89 (1) 51-8

Controversy exists as the predictors of mortality after AVR and influence of PPM Between 1982-2003 in just over 3000 pts this group from Vancouver showed at 15 year survival that PPM is not a predictor after AVR regardless of EOAi This was adjusted when Ejection fraction was > 50%. Also, there did appear to be a worsening outcome in those with a severe EOAi (so this might be a bad omen)


Prevail Transpical study--- SAPIEN XT Jan 22-2013 Multi-center (mostly German centers)

1 year outcomes from 150 patients survival 91% at 30 days and 77.9%at 1 year. moderate AI was 4% and mild in 12% Stroke was only 1 patient


Valve-sparing aortic root replacement: Equivalent long-term outcome for different valve types with or without connective tissue disorders presented at AATS 2012 Craig Miller from Stanford

233 pts (27% BAV and 43% marfan) underwent David I or David V (stanford modification) from 1993 to 2009. Mean pt f/u 4.7 years survival was 5, 10, 15 was 98%, 93% and 93% Freedom from re-operation (all causes) on the aortic root was 93% at 15 years Freedom from SVD was 96% at 15 years Freedom from >2+ AR was 95% at 15 years Conclusion: Valve sparing has excellent 10 year clinical and valve function outcomes in BAV and connective tissue disorder


Sutureless Aortic valve replacement as an alternative treatment for patients belonging to the "grey zone" between transcatheter aortic valve implantation and conventional surgery: AATS Group from Italy--Alfieri

Suture-less AVR was compared to TA-TAVI and basically had 3 matches. No difference in stroke, MI, and hospital mortality. the conclusion is that SU-AVR is a safe and effected as TA-TAVI and that it is associated with lower rate of post procedural paravalvular leak (16% vs 45%)


Update on Reintervention and risk factors for re-operation in 2000 patients after the Ross Procedure--Results of the German-Dutch Ross Registry AATS

2023 pts mean age of 39 underwent a Ross. Mean f/u was 71. +/- 4.5 years Freedom from autograft reintervention was 87% at 10 years and 83% at 12 years The risk for reoperation depends on the utilized techqniue. The subcoronary Ross technique appears to result in superior durability. Freedom from homograft reoperation was 93% at 10 years and 91% at 12 years


What study is best to source for freedom from SVD for bioprosthetic valves

The work of Dr. Jamieson (Vancouver) Use the Following predictors of 10 year SVD for Pericardiac Aortic valves Age < 35 36-50 51-64 65-69 > 70 57% 65-70% 79% 85% 95%


What is the data at 2 year in the PARTNER B Trial

Factor Standard TAVI All cause mortality 68 43 stroke 5.5 13.8 repeat hosp 72 35 Cardiac death 62 31


What are 2 year outcomes from PARTNER A

Outcome SurgAVR TAVI Death 35 33 Stroke 6.5 11.2 Major vascular 3.8 11.6


What are 2 year outcomes for PARTNER B based on STS score

STS < 5%---Significant mortality benefit STS 5- 15%--Significant mortality benefit STS > 15% No benefit/no difference between the two therapy (both bad outcomes)


Describe a study regarding AVR in asymptomatic pts with severe Aortic stenosis

Brown et al (Mayo) The prevalence of AS is 2.9% of general population They showed a survival advantage in pts with severe AS who underwent an AVR over patients who remained asymptomatic and did no undergo valve replacement. Important feature of this study is that there was no difference in late survival suggesting that the risk of aortic valve prosthesis related complications and death maybe overestimated with the use of modern mechanical valves and bioprothesthic valves may actual have longer durabilty


Name a study with outcomes for BAV pts undergoing aortic valve repair

Munir et al.,JTCS 2010 : Repair of regurgitant bicuspid aortic valves: a systemic approach Long term survival at 8 year 97% Freedom from redo AVR at 5 years was 98% and at 8 years 875 A possible predictor for failure was an aortic root greater then 4.5cm (therefore in these patients should likely do an entire root. A pericardial patch in an adult also showed early failure


When is the Ross operation a good option to treat aortic valve disease Tirone David JTCS 2010;139: 68-75

212 pts underwent Ross mean age 34 +/- 9 survival at 15 years was 96.6% Freedom from reoperation in the pulmonary autograft was 90% freedom from moderate AI at 15 years was 89% Males, aortic/pulmonary mismatch, aortic annulus of 27mm or larger, and pre-operative AI was associated with higher rates of late AI. best outcomes in females, withe AS and with an annulus < 27mm


Partner A cohort N Eng J Med 2011. Jun 9;364(23)2187-98

Purpose: determine the safety and effectiveness of the device and delivery systems (transfemoral and transapical) in high right, symptomatic patients with severe AS At 30 days Reduced all cause death (3.4% vs 6.5% p = 0.007) increased risk of major vascular complications (11% vs 3.25%) Similar stroke; Significantly improved symptoms At 1 year similar all cause death 24.2 vs 26.8%; similar/increased stroke rate 5.1% vs 2.4% At 2 years (NEJM March 2012): Similar rates of death of any cause (33.9% vs 35.0%) similar rates of stroke increased rate of paravalvular reguritation

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