[Transcatheter Aortic Valve Implantation versus surgical aortic valve replacement in intermediate-risk patients with severe symptomatic aortic stenosis].

Aortic valve stenosis (AS) is the most commonly operated valvular heart disease in developed countries. Aortic valve replacement is the sole effective treatment of symptomatic patients. PARTNER-1 (Placement of AoRtic TraNscathetER Valves) has recently proved the efficacy of percutaneous aortic valve replacement (TAVI : Transcatheter Aortic Valve Implantation) in patients at high surgical risk, or inoperable. In the present article, we report and discuss the results of the PARTNER-2 study in intermediate risk patients. Data from PARTNER-2 confirmed those of PARTNER-1 with a similar rate of combined events (death or disabling stroke) in the TAVI and surgical groups. At 2 years, the Kaplan-Meier event rates were 19.3% in the TAVI group and 21.1% in the surgery group, with a hazard ratio in the TAVI group of 0.89. The non inferiority analysis was validated with a p inferior to 0.001. In the transfemoral-access cohort, TAVI resulted in a lower rate of death or disabling stroke than surgery (p = 0.05), whereas, in the transthoracic access cohort, outcomes were similar in the two groups. Finally, TAVI was associated with lower rates of new onset atrial fibrillation, acute renal failure, and severe bleeding, whereas surgery resulted in fewer major vascular complications and less paravalvular aortic regurgitation.