Thourani Vinod H, Leon Martin B, Makkar Raj, Ascione Guido, Szeto Wilson Y, Madhavan Mahesh V, Kodali Susheel K, Hahn Rebecca T, Pibarot Philippe, Malaisrie S Chris, Kapadia Samir R, Russo Mark J, Herrmann Howard C, Babaliaros Vasilis, Guyton Robert, Genereux Philippe, Cohen David J, Park Brandon, Clarke Sarah, Gunnarsson Marissa, Szerlip Molly, Ternacle Julien, Leipsic Jonathon, Blanke Philipp, Webb John G, Smith Craig R, Mack Michael J
Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia.
Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York.
Ann Thorac Surg. 2025 Mar;119(3):555-566. doi: 10.1016/j.athoracsur.2024.11.025. Epub 2024 Dec 16.
Surgery remains an important treatment for low-risk patients with severe symptomatic aortic stenosis (AS). This study evaluated 5-year outcomes in low-risk patients undergoing isolated surgical aortic valve replacement (SAVR) or SAVR with concomitant procedures within the randomized Placement of Aortic Transcatheter Valves (PARTNER) 3 trial.
In the PARTNER 3 trial, 454 patients underwent surgery for severe, symptomatic, trileaflet AS and were followed up for 5 years. Patients were stratified into those undergoing isolated SAVR (n = 334; 73.6%) vs concomitant SAVR (n = 120; 26.4%). Short- and long-term morbidity was adjudicated by a Clinical Events Committee. Hemodynamic valve performance was evaluated by an echocardiographic core laboratory. Patient-reported health status was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ).
The mean age of participants was 73.6 ± 6.1 years; 71.1% of these patients were male. The median SAVR implant size was 23 mm overall. Five-year all-cause mortality (with vital status sweep) was 9.0% for all patients (8.5% isolated SAVR; 10.2% concomitant SAVR; P = .58), comparable to a recent analysis of low-risk isolated SAVR-treated patients in the STS database (overall mortality, 7.1%). The average 5-year mean gradient was 11.7 ± 5.6 mm Hg overall. Reintervention rates were low in both groups (isolated SAVR, 2.3% vs concomitant SAVR, 5.0%; P = .21), and most patients (isolated SAVR, 87.9%; concomitant SAVR, 86.1%) were alive with no evidence of bioprosthetic valve failure at 5 years.
SAVR in low-risk patients in the PARTNER 3 trial demonstrated excellent 5-year outcomes. Five-year mortality was similar in patients undergoing isolated SAVR vs concomitant SAVR. This result was comparable to recently published national SAVR outcomes, thus demonstrating the generalizability of these findings.
对于有症状的重度主动脉瓣狭窄（AS）低风险患者，手术仍是重要的治疗方法。本研究在随机的主动脉经导管瓣膜置入（PARTNER）3试验中，评估了接受单纯外科主动脉瓣置换术（SAVR）或同期进行其他手术的SAVR的低风险患者的5年预后。
在PARTNER 3试验中，454例有症状的重度三叶瓣AS患者接受了手术，并进行了5年随访。患者被分为接受单纯SAVR组（n = 334；73.6%）和同期SAVR组（n = 120；26.4%）。短期和长期发病率由临床事件委员会判定。血流动力学瓣膜性能由超声心动图核心实验室评估。患者报告的健康状况采用堪萨斯城心肌病问卷（KCCQ）进行测量。
参与者的平均年龄为73.6±6.1岁；其中71.1%为男性。总体SAVR植入瓣膜的中位尺寸为23 mm。所有患者的5年全因死亡率（包括生存状态普查）为9.0%（单纯SAVR组为8.5%；同期SAVR组为10.2%；P = 0.58），与近期对胸外科医师协会（STS）数据库中低风险单纯SAVR治疗患者的分析结果（总体死亡率为7.1%）相当。总体5年平均跨瓣压差平均为11.7±5.6 mmHg。两组的再次干预率均较低（单纯SAVR组为2.3%，同期SAVR组为5.0%；P = 0.21），大多数患者（单纯SAVR组为87.9%，同期SAVR组为86.1%）在5年时存活，且无生物瓣失败的证据。
PARTNER 3试验中低风险患者的SAVR显示出优异的5年预后。单纯SAVR组和同期SAVR组患者的5年死亡率相似。这一结果与近期发表的全国SAVR结局相当，从而证明了这些发现的可推广性。
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