{ "abstract": "BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an established alternative to surgical aortic valve replacement for symptomatic severe aortic stenosis, but long-term, comparative clinical outcomes and echocardiography data are lacking. OBJECTIVES: Our goal was to compare 10-year clinical and echocardiographic outcomes after balloon-expandable TAVR or surgery in intermediate-risk surgical patients in the PARTNER 2A randomized trial. METHODS: Between 2011 and 2013, patients with severe, symptomatic aortic stenosis at intermediate surgical risk were randomized at 57 centers to TAVR with the balloon-expandable SAPIEN XT system (Edwards Lifesciences) or to surgery. Randomization was stratified by anatomical suitability for transfemoral (TF) or transthoracic (transapical/transaortic [TA/TAo]) access. Ten-year outcomes were evaluated in the valve implant population and included all-cause mortality, aortic valve reintervention, and core laboratory-adjudicated echocardiographic outcomes. To obtain 10-year data, patient reconsent at 5 years was required, and vital status sweeps were implemented to improve data completeness for all-cause mortality. RESULTS: Among 1,910 randomized patients who received a valve, 974 underwent TAVR (TF: 749/974 [76.9%]) and 936 had surgery. Mean patient age was 81.6 years, 45.4% were women, and the mean Society of Thoracic Surgeons score was 5.8%. At 10 years, vital status was available for 881 of 974 patients (90.5%) and 838 of 936 patients (89.5%). All-cause 10-year mortality with vital status sweeps was 86.1% after TAVR and 82.8% after surgery (HR: 1.13; 95% CI: 1.02-1.25; P = 0.02). When stratified by access route, rates of all-cause mortality for TAVR and surgery in the TF group were similar (83.9% vs 82.1%, respectively; P = 0.27), whereas mortality was higher for TAVR in the TA/TAo group (93.2% vs 85.1%; P < 0.01; P for interaction = 0.03). Cumulative incidence rates of aortic valve reintervention at 10 years were 6.3% for TAVR and 1.6% for surgery (P < 0.001). Of the 24 TAVR and 35 surgical patients with available echocardiographic data at 10 years, mean gradients were 12.6 mm Hg and 12.7 mm Hg, respectively. CONCLUSIONS: At the 10-year follow-up, TAVR in intermediate-risk patients with the SAPIEN XT prosthesis compared with surgery was associated with lower survival rates, with differences predominantly observed in the TA/TAo access cohort. TAVR with the XT valve was also associated with significantly higher rates of aortic valve reintervention. (PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - XT Intermediate and High Risk [PII A]; NCT01314313).", "abstract_shown": true, "affiliations": [ "Piedmont Heart Institute, Atlanta, Georgia, USA. Electronic address: Vinod.Thourani@piedmont.org", "Cardiovascular Research Foundation, New York, New York, USA", "The Heart Hospital Baylor Scott and White Plano, Plano, Texas, USA", "Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA", "Emory University Hospital, Atlanta, Georgia, USA", "Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA", "Stanford Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, USA", "Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA", "Section of Interventional Cardiology, Washington Hospital Center, Washington, DC, USA", "Austin Heart, Austin, Texas, USA", "Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA", "Cardiovascular Division, Washington University/Barnes Jewish Hospital, St Louis, Missouri, USA", "Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA", "Medical City Dallas Hospital, Dallas, Texas, USA", "Valve Science Center, Allina Health Minneapolis Heart Institute, Minneapolis, Minnesota, USA", "University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA", "Edwards Lifesciences, Irvine, California, USA", "Cardiovascular Research Foundation, New York, New York, USA; St Francis Hospital and Heart Center, Roslyn, New York, USA", "Division of Cardiovascular Medicine, Stanford Health Care, Stanford, California, USA", "Quebec Heart & Lung Institute, Université Laval, Quebec, Quebec, Canada", "Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA", "Cedars-Sinai Medical Center, Los Angeles, California, USA" ], "article_type": null, "arxiv": null, "author_total": 25, "authors": [ { "affs": [ 0 ], "name": "Vinod H. Thourani", "orcid": "0000-0002-9309-2623" }, { "affs": [ 1 ], "name": "Philipp von Stein", "orcid": "0000-0003-4548-3897" }, { "affs": [ 2 ], "name": "Michael J. Mack", "orcid": "0000-0002-3148-9158" }, { "affs": [ 3 ], "name": "Tamim M. Nazif", "orcid": "0000-0003-1239-2489" }, { "affs": [ 4 ], "name": "Vasilis C. Babaliaros", "orcid": "0000-0002-9438-0846" }, { "affs": [ 5 ], "name": "Mohamad Adnan Alkhouli", "orcid": "0000-0003-3847-0959" }, { "affs": [ 6 ], "name": "Michael P. Fischbein", "orcid": "0000-0002-0638-2025" }, { "affs": [ 7 ], "name": "Nimesh D. Desai", "orcid": "0000-0002-4456-5674" }, { "affs": [ 8 ], "name": "Lowell Satler" }, { "affs": [ 9 ], "name": "Frank J. Zidar" }, { "affs": [ 3 ], "name": "Susheel Kodali", "orcid": "0000-0003-0517-2074" }, { "affs": [ 10 ], "name": "Irving L. Kron" }, { "affs": [ 11 ], "name": "Alan Zajarías", "orcid": "0009-0009-5765-640X" }, { "affs": [ 2 ], "name": "W B Brinkman" }, { "affs": [ 12 ], "name": "Samir Ramesh Kapadia", "orcid": "0000-0002-0026-3391" }, { "affs": [ 13 ], "name": "Todd M. Dewey" }, { "affs": [ 14 ], "name": "Mario Gössl", "orcid": "0000-0003-1616-8425" }, { "affs": [ 15 ], "name": "Robert Mark Bodenhamer" }, { "affs": [ 16 ], "name": "Ying Ma", "orcid": "0009-0009-5744-5370" }, { "affs": [ 17 ], "name": "David J. Cohen", "orcid": "0000-0001-9163-724X" }, { "affs": [ 18 ], "name": "Rahul Prakash Sharma", "orcid": "0000-0002-8530-5035" }, { "affs": [ 19 ], "name": "Philippe Pîbarot", "orcid": "0000-0002-3607-279X" }, { "affs": [ 20 ], "name": "Rebecca Tung Hahn", "orcid": "0000-0003-1342-9191" }, { "affs": [ 20 ], "name": "Martin B. Leon", "orcid": "0000-0002-2002-7492" }, { "affs": [ 21 ], "name": "Raj Makkar", "orcid": "0000-0002-6613-519X" } ], "bibtex": "https://research.draconitic.com/paper/dasf4h7h2j1v2.bib", "cited_by": 8, "doi": "10.1016/j.jacc.2026.03.169", "fulltext_url": null, "id": "dasf4h7h2j1v2", "issns": [ "0735-1097", "1558-3597" ], "landing_url": "https://doi.org/10.1016/j.jacc.2026.03.169", "language": "en", "licence": "CC-BY-NC-ND", "licence_label": "CC BY-NC-ND", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2705|Cardiac Valve Diseases and Treatments" ] ], "openalex": "W7164929114", "pdf_url": null, "pmcid": null, "pmid": "42300821", "published": "2026-06-01", "publisher": "Elsevier BV", "ris": "https://research.draconitic.com/paper/dasf4h7h2j1v2.ris", "sources": [ { "first_seen": "2026-11-01T13:20:20Z", "native_id": "W7164929114", "source": "openalex", "url": "https://doi.org/10.1016/j.jacc.2026.03.169" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2705|Cardiac Valve Diseases and Treatments", "subfield": "cardiovascular" } ], "title": "10-Year Randomized Outcomes of Transcatheter or Surgical Aortic Valve Replacement in Intermediate-Risk Aortic Stenosis", "title_text": "10-Year Randomized Outcomes of Transcatheter or Surgical Aortic Valve Replacement in Intermediate-Risk Aortic Stenosis", "type": "peer-reviewed", "updated_at": "2026-11-03T13:20:37Z", "url": "https://research.draconitic.com/paper/dasf4h7h2j1v2", "venue": "Journal of the American College of Cardiology", "versions": [] }