Impact of Aortic Annulus Size on Outcomes After Aortic Valve Replacement: The PARTNER 3 Trial
- Journal
- JACC. Cardiovascular interventions (Q1)
- Published
- 27 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Mahesh V Madhavan, Michael J Mack, Philippe Pibarot, Rebecca T Hahn, Raj Makkar, Vinod H Thourani, et al.
- PMID
- 42508852
- DOI
- 10.1016/j.jcin.2026.05.023
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (top studies of the week, 18 October 2026): PARTNER 3 TAVR vs SAVR by annulus size
Abstract
BACKGROUND: There are limited studies comparing the impact of transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) by annular size. OBJECTIVES: The aim of this post hoc analysis from the PARTNER (Placement of Aortic Transcatheter Valves) 3 trial was to assess the relationship between annular size and outcomes among patients with severe aortic stenosis (AS) who underwent TAVR or SAVR. METHODS: Low-risk patients with severe, symptomatic AS were randomized to TAVR using the balloon-expandable SAPIEN 3 valve or SAVR. Patients were stratified by computed tomographic angiography-derived aortic annular area (small, ≤430 mm2; large, >430 mm2). The primary endpoint was the composite of death, stroke, or rehospitalization. Interactions among annular size, treatment strategy, and adjudicated 5-year clinical outcomes were assessed. RESULTS: Of the 925 patients with available computed tomographic angiography-derived annular size, 293 had small and 632 had large aortic annuli, respectively. Median follow-up duration was 5.2 years (Q1-Q3: 5.0-6.0 years). Five-year rates of the primary endpoint were similar for TAVR and SAVR in the overall cohort, results that were consistent for patients with small (21.2% vs 31.0%; OR: 0.60; 95% CI: 0.35-1.02) and large (23.5% vs 25.5%; OR: 0.90; 95% CI: 0.62-1.29) annuli, without effect modification by annular size (P for interaction = 0.22). Rates of bioprosthetic valve failure were similar and low at 5 years, without effect modification by annular size. Five-year health status was also similar between treatment modalities across annulus strata (P for interaction = 0.12). CONCLUSIONS: TAVR with the SAPIEN 3 valve led to similar 5-year clinical and health status outcomes compared with SAVR, irrespective of annular size. (PARTNER 3 Trial: Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis [P3]; NCT02675114).
Abstract as published, via PubMed.
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