The five-year outcome of the transcatheter aortic valve replacement in the partner 2A study in patients with intermediate surgical risk—what is clear and what it is unclear

摘要

The 5-year results of the PARTNER 2A study of the transcatheter aortic valve replacement (TAVR) in patients with intermediate surgical risk were recently published in the New England Journal of Medicine (1). At its first publication in the same journal, in July 2017 (2), the study was accepted by the scientific community as a confirmation that transcatheter technique can also be applied to patients with intermediate-risk aortic stenosis. Precisely in light of the results of the PANTER 2A study and the Pivotal trial (3) (who used the self-expanding (SE) valve in the same type of patients), the ESC guidelines published in the same year considered in Class 1 level of evidence B the indication for surgical replacement or percutaneous implantation of the aortic valve in patients with STS score ≥4 (or with other comorbidities not including risk scores such as fragility, the presence of porcelain aorta or previous chest radiation therapy) with evaluation by the heart team and preferring the percutaneous procedure in elderly patients and when the procedure is feasible for transfemoral access (4,5).