One year follow-up of the multi-centre European PARTNER transcatheter heart valve study

Thierry Lefèvre, Ari Pieter Kappetein, Ernst Wolner, Patrick Nataf, Martyn Thomas, Volker Schächinger, Bernard De Bruyne, Hélène Eltchaninoff, Matthias Thielmann, Dominique Himbert, Mauro Romano, Patrick Serruys, Gerhard Wimmer-Greinecker, PARTNER EU Investigator Group, H Baumgartner, D Glogar, M T Kasimir, P Simon, W Wisser, E Wolner, N Al-Attar, D Himbert, P Nataf, A Vahanian, A El-Gamel, P MacCarthy, M Thomas, O Wendler, H Eggebrecht, R Erbel, H Jakob, P Kahlert, S Sack, M Thielmann, D Wendt, P Donzeau-Gouge, A Farge, T Lefevre, M-C Morice, M Romano, F Casselman, B De Bruyne, I Degrieck, Marc Vanderheyden, H Vanermen, J-P Bessou, A Cribier, H Eltchaninoff, Y-P Litzler, M Doss, S Fichtlscherer, V Schächinger, G Wimmer-Greinecker, P DeJaegere, A P Kappetein, P Serruys, Thierry Lefèvre, Ari Pieter Kappetein, Ernst Wolner, Patrick Nataf, Martyn Thomas, Volker Schächinger, Bernard De Bruyne, Hélène Eltchaninoff, Matthias Thielmann, Dominique Himbert, Mauro Romano, Patrick Serruys, Gerhard Wimmer-Greinecker, PARTNER EU Investigator Group, H Baumgartner, D Glogar, M T Kasimir, P Simon, W Wisser, E Wolner, N Al-Attar, D Himbert, P Nataf, A Vahanian, A El-Gamel, P MacCarthy, M Thomas, O Wendler, H Eggebrecht, R Erbel, H Jakob, P Kahlert, S Sack, M Thielmann, D Wendt, P Donzeau-Gouge, A Farge, T Lefevre, M-C Morice, M Romano, F Casselman, B De Bruyne, I Degrieck, Marc Vanderheyden, H Vanermen, J-P Bessou, A Cribier, H Eltchaninoff, Y-P Litzler, M Doss, S Fichtlscherer, V Schächinger, G Wimmer-Greinecker, P DeJaegere, A P Kappetein, P Serruys

Abstract

Background: Transcatheter aortic valve implantation (TAVI) has emerged as a new therapeutic option in high-risk patients with severe aortic stenosis.

Aims: PARTNER EU is the first study to evaluate prospectively the procedural and mid-term outcomes of transfemoral (TF) or transapical (TA) implantation of the Edwards SAPIEN® valve involving a multi-disciplinary approach.

Methods and results: Primary safety endpoints were 30 days and 6 months mortality. Primary efficacy endpoints were haemodynamic and functional improvement at 12 months. One hundred and thirty patients (61 TF, 69 TA), aged 82.1 ± 5.5 years were included. TA patients had higher logistic EuroSCORE (33.8 vs. 25.7%, P = 0.0005) and more peripheral disease (49.3 vs. 16.4%, P< 0.0001). Procedures were aborted in four TA (5.8%) and six TF cases (9.8%). Valve implantation was successful in the remaining patients in 95.4 and 96.4%, respectively. Thirty days and 6 months survival were 81.2 and 58.0% (TA) and 91.8 and 90.2% (TF). In both groups, mean aortic gradient decreased from 46.9 ± 18.1 to 10.9 ± 5.4 mmHg 6 months post-TAVI. In total, 78.1 and 84.8% of patients experienced significant improvement in New York Heart Association (NYHA) class, whereas 73.9 and 72.7% had improved Kansas City Cardiomyopathy Questionnaire (KCCQ) scores in TA and TF cohorts, respectively.

Conclusion: This first team-based multi-centre European TAVI registry shows promising results in high-risk patients treated by TF or TA delivery. Survival rates differ significantly between TF and TA groups and probably reflect the higher risk profile of the TA cohort. Optimal patient screening, approach selection, and device refinement may improve outcomes.

Figures

Figure 1
Figure 1
Procedural outcome.
Figure 2
Figure 2
(A) Overall survival for transapical patients. (B) Overall survival for transfemoral patients.
Figure 3
Figure 3
Predicted 1 year mortality vs. Logistic Euroscore.

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