(Press-News.org) SAN DIEGO (March 15, 2015) -- The SAPIEN 3 heart valve demonstrated lower death, stroke and paravalvular leak rates than earlier generation devices in patients at high risk for surgery and showed encouraging results in intermediate-risk patients, according to research presented at the American College of Cardiology's 64th Annual Scientific Session.
Transcatheter aortic valve replacement, known as TAVR, is approved for patients with severe aortic stenosis--narrowing of the valve in the heart's main artery--whose health profile makes them ineligible or high-risk candidates for surgery. This trial, called PARTNER II S3, evaluated 30-day outcomes with the SAPIEN 3 valve, the latest modification of the balloon-expandable system used in these procedures. This is the first presentation of large-scale data for the third-generation device and the first report of outcomes in intermediate-risk patients in the United States.
In addition to the study's 583 high-risk or inoperable patients, 1,076 intermediate-risk patients were treated with the new device. The death rate was 2.2 percent, or 13 patients, in the high-risk group and 1.1 percent, or 12 deaths, in the intermediate-risk group. Heart-related deaths accounted for 1.4 percent of the mortality in the high-risk group and 0.9 percent in the intermediate-risk group. High-risk patients had a stroke rate of 1.5 percent, 0.9 percent of them disabling; in the intermediate-risk group, those rates were 2.6 percent and 1 percent, respectively.
"The 30-day mortality rates were extremely low, stroke rates were approximately 1 percent in both groups and significant paravalvular regurgitation was rare," said Susheel Kodali, M.D., director of the Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York City, and a co-principal investigator of the study. "Death and stroke rates have been decreasing with every modification of the SAPIEN system."
Major vascular complications occurred in about 5 percent of high- and intermediate-risk patients, a reduction of two-thirds compared with the first-generation SAPIEN system. Other clinical events also were reduced from results in previous SAPIEN studies, including heart attacks in 0.5 percent of patients, injury to the aortic area called annular rupture in 0.3 percent and coronary obstruction in 0.3 percent. A new permanent pacemaker was implanted in 13 percent of high-risk patients and 10 percent of intermediate-risk patients, a slightly higher rate than with earlier balloon-expandable valves.
Paravalvular leak has been associated with poorer outcomes after TAVR. The third-generation model used in this study was modified with an outer skirt designed to reduce leak by sealing gaps around the valve. With the new device, 3.7 percent of patients had moderate leak and 0.1 percent had severe leak. By comparison, currently approved devices have rates of moderate or severe paravalvular leak in the range of 10 to 20 percent.
Other alterations allow the valve to be delivered with a smaller catheter, increasing the percentage of procedures that can be performed via the femoral artery, a route preferred because of better outcomes. When transfemoral delivery is not possible, the route is generally through the ribs.
"For the first SAPIEN devices, we were able to use the less invasive transfemoral approach in about 60 percent of patients," Kodali said. "For SAPIEN 3, more than 90 percent of procedures can be transfemoral."
One-year data for high-risk patients with the new device will be available later in 2015. Longer-term outcomes for the intermediate-risk patients treated with the new device will be compared with the intermediate-risk surgical patients in the PARTNER IIA trial once the two-year endpoint is reached. Patients will be followed for five years.
"We needed to see if we've solved the valve leakage issue before we move to lower-risk patients," Kodali said. "Although we have to wait for longer-term data, what we've seen thus far makes us excited about those data and what they'll show."
Kodali emphasized that these are 30-day data and that longer-term follow up is required.
INFORMATION:
Edwards Lifesciences sponsored the trial. The hospital conducts training programs for the company, and Kodali receives compensation from the company for travel related to the trial.
Special note: Michael Davidson, a surgeon from Boston and one of the original PARTNER clinical trial investigators, was killed in January at the age of 44 by the son of a former patient. ACC and the PARTNER trial team dedicate this presentation and journal paper to his memory.
The ACC's Annual Scientific Session brings together cardiologists and cardiovascular specialists from around the world each year to share the newest discoveries in treatment and prevention. Follow @ACCMediaCenter and #ACC15 for the latest news from the meeting.
The American College of Cardiology is a 49,000-member medical society that is the professional home for the entire cardiovascular care team. The mission of the College is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy, standards and guidelines. The College operates national registries to measure and improve care, provides professional medical education, disseminates cardiovascular research and bestows credentials upon cardiovascular specialists who meet stringent qualifications. For more information, visit acc.org.
SAN DIEGO (March 15, 2015) -- An investigational device that deflects debris away from the brain during transcatheter aortic valve replacement seems to improve in-hospital safety outcomes and cognitive scores at discharge, according to preliminary findings from a small randomized study presented at the American College of Cardiology's 64th Annual Scientific Session.
The valve replacement procedure, known as TAVR, dislodges minute particles from the clogged valve, freeing them to float through the bloodstream. Much of this debris travels "downstream" from the heart, but ...
SAN DIEGO (March 15, 2015) -- Five-year data suggest that the SAPIEN transcatheter heart valve is a feasible option for patients with severe aortic stenosis deemed to be at high risk for open-heart surgery, though valve leakage was more common with the first-generation valve evaluated in this study than with surgery, according to research from PARTNER I presented at the American College of Cardiology's 64th Annual Scientific Session.
When the blockage of an aortic valve becomes severe, replacement is the only real treatment choice, but many elderly and frail people are ...
SAN DIEGO (March 15, 2015) -- Two-year data show a continued survival advantage for self-expanding transcatheter aortic valve replacement (TAVR) over standard surgery in high-risk patients with severe aortic stenosis, according to research presented at the American College of Cardiology's 64th Annual Scientific Session.
Aortic stenosis--a problem that occurs when the valve in the heart's main artery doesn't open fully--forces the heart to work harder to pump blood and is life-threatening over time. Valve replacement is common when this condition becomes severe, but the ...
SAN DIEGO (March 15, 2015) --The commercial track record with transcatheter mitral valve repair, approved for patients at high risk for surgery, compares favorably with pre-approval reports, according to findings from a U.S. registry presented at the American College of Cardiology's 64th Annual Scientific Session.
Healthy valves function as one-way gates that keep blood moving forward through the heart. Severely damaged mitral valves don't close properly, allowing blood to leak backward. If the valve isn't repaired or replaced, the condition can cause serious health ...
Police are ill-equipped to investigate non-criminal deaths and face a challenge to avoid re-traumatising bereaved families as well as emotionally protecting themselves, according to QUT research.
Investigating death: the emotional and cultural challenges for police found it was usually junior officers sent to sudden death investigations and tasked with not only gathering evidence, but also comforting family members and explaining the coronial process.
The research has been published in the journal of Policing and Society.
"The vast majority of deaths are neither ...
NEW YORK, NY - Researchers have built a new computational tool that identifies 800 different ways people are at increased risk for post-traumatic stress disorder (PTSD), permitting for the first time a personalized prediction guide.
Results from the study out of NYU Langone Medical Center are published online (date) in the journal BMC Psychiatry.
"Our study shows that high-risk individuals who have experienced a traumatic event can be identified less than two weeks after they are first seen in the emergency department," says Arieh Y. Shalev, MD, the Barbara Wilson ...
NEW YORK, March 15, 2015 - Most physicians are aware of the importance of lifestyle factors in preventing cardiovascular disease (CVD) -- and believe diet is as important as statin therapy and exercise, according to a new survey from NYU Langone Medical Center.
Researchers found that a majority of doctors would welcome additional training in diet and nutrition so that they can effectively inform patients on the subject. The study will be presented at the American College of Cardiology's 64th Annual Scientific Session as a poster presentation.
The 28-question online survey, ...
NEW YORK, March 4, 2015 - Air pollution has been linked to a dangerous narrowing of neck arteries that occurs prior to strokes, according to researchers at NYU Langone Medical Center.
The scientists analyzed medical test records for more than 300,000 people living in New York, New Jersey or Connecticut. They found that people living in zip codes with the highest average levels of fine-particulate-matter pollution were significantly more likely to show signs of narrowing (stenosis) in their internal carotid arteries, compared to those living in zip codes with the lowest ...
March 16, 2015, New York, NY - Exploring the fundamental mechanism by which a cell-surface receptor transmits its signal, an international team of Ludwig researchers and their colleagues has established proof of concept for an entirely new approach to drug design. They report that a class of synthetic molecules known as diabodies can, from outside the cell, latch onto a target receptor and manipulate it in such a manner as to induce distinct and varying effects within cells and tissues. Led by Christopher Garcia of Ludwig Stanford, the researchers show in lab experiments ...
Carnivorous plants have strange-shaped leaves, and they can grow on nutrient-poor environments by trapping and eating small animals. Charles Darwin, often called "the father of evolution", was also interested in carnivorous plants, and he wrote a book titled "Insectivorous Plants" published in 1875. Since then a lot of researches have been done, but how such strange-shaped leaves were altered during evolution remained unknown.
A research team in Japan has revealed how carnivorous pitcher leaves are formed in Sarracenia purpurea, a carnivorous plant native to North America. ...
