prikaz prve stranice dokumenta Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis: The AVATAR Trial
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Scientific paper - Original scientific paper
Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis: The AVATAR Trial
Circulation, 145 (2022), 9; 648-658. https://doi.org/10.1161/CIRCULATIONAHA.121.057639
(AVATAR Trial Investigators) Banovic, Marko; Putnik, Svetozar; Penicka, Martin; Doros, Gheorghe; Deja, Marek A.; Kockova, Radka; Kotrc, Martin; Glaveckaite, Sigita; Gašparović, Hrvoje; Pavlović, Nikola; Velicki, Lazar; Salizzoni, Stefano; Wojakowski, Wojtek; Van Camp, Guy; Nikolic, Serge D.; Iung, Bernard; Bartunek, Jozef More authors...

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Banovic, M., Putnik, S., Penicka, M., Doros, G., Deja, M. A., Kockova, R. ... Bartunek, J. (2022). Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis: The AVATAR Trial. Circulation, 145. (9), 648-658. doi: 10.1161/CIRCULATIONAHA.121.057639

Banovic, Marko, et al. "Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis: The AVATAR Trial." Circulation, vol. 145, no. 9, 2022, pp. 648-658. https://doi.org/10.1161/CIRCULATIONAHA.121.057639

Banovic, Marko, Svetozar Putnik, Martin Penicka, Gheorghe Doros, Marek A. Deja, Radka Kockova, Martin Kotrc, et al. "Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis: The AVATAR Trial." Circulation 145, no. 9 (2022): 648-658. https://doi.org/10.1161/CIRCULATIONAHA.121.057639

Banovic, M., et al. (2022) 'Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis: The AVATAR Trial', Circulation, 145(9), pp. 648-658. doi: 10.1161/CIRCULATIONAHA.121.057639

Banovic M, Putnik S, Penicka M, Doros G, Deja MA, Kockova R, and sur.. Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis: The AVATAR Trial. Circulation [Internet]. 2022 March [cited 2024 May 05];145(9):648-658. doi: 10.1161/CIRCULATIONAHA.121.057639

M. Banovic, et al., "Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis: The AVATAR Trial", Circulation, vol. 145, no. 9, pp. 648-658, March 2022. [Online]. Available at: https://urn.nsk.hr/urn:nbn:hr:105:007779. [Accessed: 05 May 2024]

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Metadata
Title (english)Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis: The AVATAR Trial
AuthorMarko Banovic
AuthorSvetozar Putnik
AuthorMartin Penicka
AuthorGheorghe Doros
AuthorMarek A. Deja
AuthorRadka Kockova
AuthorMartin Kotrc
AuthorSigita Glaveckaite
AuthorHrvoje Gašparović
AuthorNikola Pavlović
AuthorLazar Velicki
AuthorStefano Salizzoni
AuthorWojtek Wojakowski
AuthorGuy Van Camp
AuthorSerge D. Nikolic
AuthorBernard Iung
AuthorJozef Bartunek
CollaborationAVATAR Trial Investigators
Author's institutionUniversity of Zagreb
School of Medicine
(Department of Surgery)
Scientific / art field,
discipline and subdiscipline		BIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Surgery
Abstract (english)
Background: Surgical aortic valve replacement (SAVR) represents a class I indication in symptomatic patients with severe aortic stenosis (AS). However, indications for early SAVR in asymptomatic patients with severe AS and normal left ventricular function remain debated. ------ Methods: The AVATAR trial (Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis) is an investigator-initiated international prospective randomized controlled trial that evaluated the safety and efficacy of early SAVR in the treatment of asymptomatic patients with severe AS, according to common criteria (valve area ≤1 cm2 with aortic jet velocity >4 m/s or a mean transaortic gradient ≥40 mm Hg), and with normal left ventricular function. Negative exercise testing was mandatory for inclusion. The primary hypothesis was that early SAVR would reduce the primary composite end point of all-cause death, acute myocardial infarction, stroke, or unplanned hospitalization for heart failure compared with a conservative strategy according to guidelines. The trial was designed as event-driven to reach a minimum of 35 prespecified events. The study was performed in 9 centers in 7 European countries. ------ Results: Between June 2015 and September 2020, 157 patients (mean age, 67 years; 57% men) were randomly allocated to early surgery (n=78) or conservative treatment (n=79). Follow-up was completed in May 2021. Overall median follow-up was 32 months: 28 months in the early surgery group and 35 months in the conservative treatment group. There was a total of 39 events, 13 in early surgery and 26 in the conservative treatment group. In the early surgery group, 72 patients (92.3%) underwent SAVR with operative mortality of 1.4%. In an intention-to-treat analysis, patients randomized to early surgery had a significantly lower incidence of primary composite end point than those in the conservative arm (hazard ratio, 0.46 [95% CI, 0.23-0.90]; P=0.02). There was no statistical difference in secondary end points, including all-cause mortality, first heart failure hospitalizations, major bleeding, or thromboembolic complications, but trends were consistent with the primary outcome. ----- Conclusions: In asymptomatic patients with severe AS, early surgery reduced a primary composite of all-cause death, acute myocardial infarction, stroke, or unplanned hospitalization for heart failure compared with conservative treatment. This randomized trial provides preliminary support for early SAVR once AS becomes severe, regardless of symptoms.
Keywords (english)
Languageenglish
Publication typeScientific paper - Original scientific paper
Publication statusPublished
Peer reviewPeer review
Publication versionPublished version
Journal titleCirculation
Numberingvol. 145, no. 9, pp. 648-658
p-ISSN0009-7322
e-ISSN1524-4539
DOIhttps://doi.org/10.1161/CIRCULATIONAHA.121.057639
URN:NBNurn:nbn:hr:105:007779
Publication2022-03
Document URLhttps://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057639
Type of resourceText
Access conditionsOpen access
Terms of useLicence Attribution 4.0 International (CC BY 4.0) icon
Created on2022-03-10 10:15:42