title: Comprehensive analysis of mortality among patients undergoing TAVR: results of the PARTNER trial.
abstract: BACKGROUND
  Patients with severe aortic stenosis (AS) who were deemed too high risk or inoperable for conventional aortic valve replacement (AVR) in the PARTNER (Placement of Aortic Transcatheter Valves) trial were randomized to transcatheter aortic valve replacement (TAVR) versus AVR (PARTNER-A arm) or standard therapy (PARTNER-B arm).
  
  
  OBJECTIVE
  This study compared when and how deaths occurred after TAVR versus surgical AVR or standard therapy.
  
  
  METHODS
  The PARTNER-A arm included 244 transfemoral (TF) and 104 transapical (TA) TAVR patients, and 351 AVR patients; the PARTNER-B arm included 179 TF-TAVR patients and 179 standard therapy patients. Deaths were categorized as cardiovascular, noncardiovascular, or uncategorizable, and were characterized by multiphase hazard modelling.
  
  
  RESULTS
  In the PARTNER-A arm, the risk of death peaked after randomization in the TA-TAVR and AVR groups, falling to low levels commensurate with the U.S. population within 3 months. Early risk was less in TF-TAVR patients, resulting in initial superior survival; between 12 and 18 months, risk increased, such that within 2 years, TF-TAVR and AVR patients had similar survival rates. Cardiovascular, noncardiovascular, and uncategorizable deaths for TF-TAVR were 37%, 43%, and 20%, respectively, versus 22%, 41%, and 37%, respectively, for TA-TAVR and 33%, 43%, and 24%, respectively, for AVR. In the PARTNER-B arm, risk with standard therapy was 60% per year; TF-TAVR reduced risk to 20% per year, resulting in 0.5 years of life added within 2.5 years.
  
  
  CONCLUSIONS
  In inoperable AS patients, TAVR substantially reduced the risk of cardiovascular death. In high-risk patients, TA-TAVR and AVR were associated with elevated peri-procedural risk more than with TF-TAVR, although cardiovascular death was higher after TF-TAVR. Therefore, TF-TAVR should be considered the standard of care for severely symptomatic inoperable patients or those at high risk of noncardiovascular mortality after conventional surgery. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).
authors.affiliation: Cleveland Clinic, Cleveland, Ohio; PARTNER Publication Office, New York, New York, and Cleveland, Ohio. Electronic address: svenssl@ccf.org.
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.affiliation: Cleveland Clinic, Cleveland, Ohio; PARTNER Publication Office, New York, New York, and Cleveland, Ohio.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.affiliation: Cleveland Clinic, Cleveland, Ohio; PARTNER Publication Office, New York, New York, and Cleveland, Ohio.
authors.forename: Jeevanantham
authors.initials: J
authors.lastname: Rajeswaran
authors.affiliation: Cleveland Clinic, Westin, Florida.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Brozzi
authors.affiliation: PARTNER Publication Office, New York, New York, and Cleveland, Ohio; Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.affiliation: Baylor Health Care System, Dallas, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
authors.affiliation: Stanford University Medical School, Stanford, California.
authors.forename: D Craig
authors.initials: DC
authors.lastname: Miller
authors.affiliation: Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.affiliation: University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Samir
authors.initials: S
authors.lastname: Kapadia
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Fontana
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
authors.affiliation: Baylor Health Care System, Dallas, Texas.
authors.forename: David L
authors.initials: DL
authors.lastname: Brown
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Block
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: Medstar Washington Hospital Center, Washington, DC.
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Howard C
authors.initials: HC
authors.lastname: Herrmann
authors.affiliation: Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York.
authors.forename: Mathew R
authors.initials: MR
authors.lastname: Williams
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Vasilis
authors.initials: V
authors.lastname: Babaliaros
authors.affiliation: Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.affiliation: Edwards Lifesciences, Irvine, California.
authors.forename: Jodi J
authors.initials: JJ
authors.lastname: Akin
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery; D006328:Cardiac Catheterization; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: TAVR; aortic stenosis; causes of death