TAVR may be superior to surgical AVR in AS patients with diabetes

  • September 9, 2013

AMSTERDAM — Transcatheter aortic valve replacement was associated with a nearly 10% lower all-cause mortality rate at 1 year compared with surgical aortic valve replacement in  patients with diabetes and aortic stenosis, according to results presented here from the PARTNER high-risk cohort trial.

The study was conducted in response to increased morbidity and mortality associated with surgical AVR in individuals with diabetes and aortic stenosis (AS), according to presenter Brian R. Lindman, MD, assistant professor of medicine in the Cardiovascular Division at the Washington University School of Medicine in St. Louis. In the current post-hoc analysis of the PARTNER cohort A trial, Lindman and colleagues aimed to investigate whether TAVR could yield improved outcomes in this patient group.

Eligible participants had severe symptomatic AS and were at a high risk for surgery. All-cause mortality at 1 year served as the primary endpoint. The analysis included 657 patients (as-treated population), of whom 275 had diabetes. In the diabetes group, 145 had undergone TAVR and 130 had undergone surgical AVR.

A significant interaction was observed between diabetes status and treatment group regarding mortality at 1 year (P=.048).

An 18% mortality rate was observed at 1 year in the TAVR/diabetes arm compared with 27.4% in the surgical AVR/diabetes arm (P=.04). Other 1-year results in the diabetes patients indicated a similar rate of stroke in each treatment group (TAVR, 3.5% vs. surgical AVR, 3.5%; P=0.88).

A consistent relationship of improved survival in the transcatheter group compared to surgery was observed in patients included in the  transfemoral or transapical placement cohorts.

In the non-diabetes group, the 1-year mortality rate was 27.8% for TAVR and 23.7% for surgical AVR, which the researchers noted was not a significant difference (P=.48).

Diabetic patients in the TAVR group experienced less renal failure requiring dialysis at 1 year than those in the surgical AVR group (4.2% vs. 10.6%). Also at this time point, 0% of individuals in the TAVR group required dialysis lasting longer than 30 days compared with 6.1% in the surgical AVR group (P<.05 for both comparisons).

For more information:

Lindman B. PARTNER: Transcatheter versus Surgical Aortic Valve Replacement in Patients with Diabetes and Severe Aortic Stenosis at High Risk for Surgery. Presented at: the European Society of Cardiology Congress; Aug. 31-Sept. 4, 2013; Amsterdam.

Disclosure: Lindman reports no relevant financial disclosures.

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