Adobe Flash Player is required to view this feature. If you are using an operating system that does not support Flash, we are working to bring you alternative formats. Original Article Two-Year Outcomes after Transcatheter or Surgical Aortic-Valve Replacement Susheel K. Kodali, M.D., Mathew R.

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Svensson, M.D., Ph.D., John G. Webb, M.D., Raj R. Makkar, M.D., Gregory P. Fontana, M.D., Todd M.

Dewey, M. Lands End. D., Vinod H. Thourani, M.D., Augusto D. Pichard, M.D., Michael Fischbein, M.D., Ph.D., Wilson Y. Szeto, M.D., Scott Lim, M.D., Kevin L. Greason, M.D., Paul S. Teirstein, M.D., S. Chris Malaisrie, M.D., Pamela S.

Douglas, M.D., Rebecca T. Hahn, M.D., Brian Whisenant, M.D., Alan Zajarias, M.D., Duolao Wang, Ph.D., Jodi J. Akin, M.S., William N. Anderson, Ph.D., and Martin B. Leon, M.D., for the PARTNER Trial Investigators N Engl J Med 2012; 366:1686-1695 DOI: 10.1056/NEJMoa1200384. Results The rates of death from any cause were similar in the TAVR and surgery groups (hazard ratio with TAVR, 0.90; 95% confidence interval [CI], 0.71 to 1.15; P=0.41) and at 2 years (Kaplan–Meier analysis) were 33.9% in the TAVR group and 35.0% in the surgery group (P=0.78).

The frequency of all strokes during follow-up did not differ significantly between the two groups (hazard ratio, 1.22; 95% CI, 0.67 to 2.23; P=0.52). At 30 days, strokes were more frequent with TAVR than with surgical replacement (4.6% vs. 2.4%, P=0.12); subsequently, there were 8 additional strokes in the TAVR group and 12 in the surgery group.

Improvement in valve areas was similar with TAVR and surgical replacement and was maintained for 2 years. Paravalvular regurgitation was more frequent after TAVR (P.

Aortic stenosis is associated with high mortality after the appearance of cardiac symptoms. Nevertheless, many patients do not undergo surgical aortic-valve replacement owing to real or perceived increased risks associated with surgery. Transcatheter aortic-valve replacement (TAVR) has emerged as an alternative therapy in high-risk patients with aortic stenosis. Observational registries from various countries have reported 1-month and 1-year outcomes after TAVR, but there are limited long-term follow-up data. The Placement of Aortic Transcatheter Valves (PARTNER) trial was a randomized trial comparing TAVR with standard-of-care therapies in high-risk patients with aortic stenosis. One-year mortality outcomes from PARTNER showed that TAVR was superior to standard therapy in patients who could not undergo surgery and was noninferior to surgical replacement in high-risk patients who could undergo surgery. However, longer-term data are required to assess valve durability and to monitor late clinical complications, before TAVR is used more widely in clinical practice.