【正文】 ortality between TAVR and surgery – Baseline predictors of mortality were different for TAVR (. BMI, PVD) and surgery (. STS score, mod/severe MR) – Symptom improvement was similar in both groups and maintained thru three years ? At 3 years, strokes were similar in TAVR and surgery patients, despite increased periprocedural neurologic events in TAVR patients – There was no late (after 30 days) stroke hazard in TAVR pared with surgery Conclusions (2) ? Echocardiographic analysis revealed… – At 3 years, TAVR hemodynamic performance was maintained with similar valve gradients and areas pared with surgery – Both AVR and surgery resulted in significant LVEF improvement and LV mass regression – Postprocedural paravalvular AR was frequent after TAVR (mildmodsevere ~ 50% pts) without important changes during 3 year FU – Even mild postprocedural AR (PVL and total AR) was associated with increased subsequent mortality Implications ? 3year results from the highrisk operable PARTNER cohort indicate… – TAVR should be considered an alternative to surgery with similar mortality and similar other major clinical outes – Periprocedural stroke concerns after TAVR have diminished with longer term followup – TAVR valve hemodynamics have remained stable, although periprocedural regurgitation (even mild) has emerged as a predictor of late mortality ? Future efforts should be directed towards reducing TAVR procedurerelated plications, including strokes, vascular events, and paravalvular regurgitation Thank you PARTNER TEAM 演講完畢，謝謝觀看！ 。 Male 201 % 198 % NYHA Class III or IV 328 % 328 % Previous CABG 148 152 Cerebrovascular disease 96 87 Peripheral vascular disease 149 142 STS Score (Mean 177。 guideline = STS Score ≥ 10 *Smith, ., et al., Transcatheter versus Surgical AorticValve Replacement in HighRisk Patients. N Engl J Med, 2023. 364(23): p. 218798. Key Exclusion Criteria ? Aortic annulus diameter (echo measurement) 18 mm or 25 mm ? Iliacfemoral anatomy precluding safe sheath insertion ? Severe LV dysfunction (LVEF 20%) ? Untreated CAD requiring revascularization Anatomic: ? Serum Cr mg/dL or dialysis dependent ? Acute MI within 1 month ? CVA or TIA within 6 months ? Hemodynamic instability Clinical: Study Devices Edwards SAPIEN THV 23 and 26 mm valves RetroFlex 22 and 24 F sheaths Ascendra 24 and 26 F sheaths Transfemoral Transapical Enrolling Study Sites Intermountain Medical Center Salt Lake City, UT Emory University Atlanta, GA Univ. of Miami Miami, FL Univ. of Virginia Charlottesville, VA St. Luke’s Hospital Kansas City, MO BarnesJewish Hospital St. Louis, MO Medical City Dallas Dallas, TX St. Paul39。 Characteristic TAVR (n