Transcatheter versus surgical aortic valve replacement in patients with diabetes and severe aortic stenosis at high risk for surgery: An analysis of the PARTNER trial (Placement of Aortic Transcatheter Valve)

Brian R. Lindman, Philippe Pibarot, Suzanne V. Arnold, Rakesh M. Suri, Thomas C. McAndrew, Hersh S. Maniar, Alan Zajarias, Susheel Kodali, Ajay J. Kirtane, Vinod H. Thourani, E. Murat Tuzcu, Lars G. Svensson, Ron Waksman, Craig R. Smith, Martin B. Leon

Research output: Contribution to journalArticlepeer-review

54 Scopus citations

Abstract

Objectives The goal of this study was to determine whether a less-invasive approach to aortic valve replacement (AVR) improves clinical outcomes in diabetic patients with aortic stenosis (AS). Background Diabetes is associated with increased morbidity and mortality after surgical AVR for AS. Methods Among treated patients with severe symptomatic AS at high risk for surgery in the PARTNER (Placement of Aortic Transcatheter Valve) trial, we examined outcomes stratified according to diabetes status of patients randomly assigned to receive transcatheter or surgical AVR. The primary outcome was all-cause mortality at 1 year. Results Among 657 patients enrolled in PARTNER who underwent treatment, there were 275 patients with diabetes (145 transcatheter, 130 surgical). There was a significant interaction between diabetes and treatment group for 1-year all-cause mortality (p = 0.048). Among diabetic patients, all-cause mortality at 1 year was 18.0% in the transcatheter group and 27.4% in the surgical group (hazard ratio: 0.60 [95% confidence interval: 0.36 to 0.99]; p = 0.04). Results were consistent among patients treated via transfemoral or transapical routes. In contrast, among nondiabetic patients, there was no significant difference in all-cause mortality at 1 year (p = 0.48). Among diabetic patients, the 1-year rates of stroke were similar between treatment groups (3.5% transcatheter vs. 3.5% surgery; p = 0.88), but the rate of renal failure requiring dialysis >30 days was lower in the transcatheter group (0% vs. 6.1%; p = 0.003). Conclusions Among patients with diabetes and severe symptomatic AS at high risk for surgery, this post-hoc stratified analysis of the PARTNER trial suggests there is a survival benefit, no increase in stroke, and less renal failure from treatment with transcatheter AVR compared with surgical AVR. (The PARTNER Trial: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894)

Original languageEnglish
Pages (from-to)1090-1099
Number of pages10
JournalJournal of the American College of Cardiology
Volume63
Issue number11
DOIs
StatePublished - Mar 25 2014

Keywords

  • aortic stenosis
  • diabetes
  • transcatheter aortic valve replacement

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