Citations 2
Evaluation of Interventions for Cognitive Symptoms in Long COVID
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JAMA Neurology | November 10, 2025 | Volume: 83 | Issue: 1 | Pages: 49
Importance Treatment for cognitive dysfunction due to postacute sequelae of long COVID (ie, symptoms of fatigue, malaise, weakness, confusion that persist beyond 12 weeks after an initial COVID infection) remains a significant unmet need. Objective To test evidence-based rehabilitation strategies for improving cognitive symptoms in persons with long COVID. Design, Setting, and Participants This was a 5-arm, multicenter, randomized clinical trial of 3 remotely delivered interventions conducted between August 17, 2023, and June 10, 2024. The study took place at 22 trial sites and included the screening of individuals with cognitive long COVID. Interventions Participants were randomized to 1 of 5 arms: adaptive computerized cognitive training (BrainHQ [Posit Science]), cognitive-behavioral rehabilitation involving both group and individual counseling sessions (PASC-Cognitive Recovery [PASC-CoRE]) paired with BrainHQ, and transcranial direct current stimulation (tDCS) paired with BrainHQ. Two comparator arms were included as follows: unstructured computer puzzles and games (active comparator) and sham tDCS paired with BrainHQ. The interventions occurred 5 times per week over 10 weeks. Main Outcomes and Measures Cognitive and behavioral in-person assessments were performed at baseline, midintervention, at the end of intervention, and 3 months after the end of the intervention. The primary outcome measure was the modified Everyday Cognition Scale 2 (ECog2) completed at the end of the intervention compared to the baseline visit based on participant self-report looking back over the prior 7 days. Results A total of 378 individuals were screened, from which there were 328 participants (median [IQR] age, 48.0 [37.0-58.0] years; 241 female [73.5%]; race: 15 Asian [4.6%], 47 Black [14.3%], and 235 White [71.6%]; ethnicity: 52 Hispanic [15.9%]). None of the 3 active interventions demonstrated benefits on the modified ECog2 in the intention-to-treat population by the end of the intervention period. The adjusted differences in mean change were 0.0 (95% CI, −0.2 to 0.2) for BrainHQ vs active comparator, 0.1 (95% CI, −0.1 to 0.3) for PASC-CoRE + BrainHQ vs active comparator, 0.0 (95% CI, −0.2 to 0.2) for tDCS-active + BrainHQ vs tDCS-sham + BrainHQ, and 0.1 (95% CI, −0.1 to 0.3) for PASC-CoRE + BrainHQ vs BrainHQ alone. Secondary participant-reported outcomes and neuropsychological tests showed no differential benefits for any treatment arm. All 5 arms demonstrated some improvements over time on the modified ECog2 and on secondary outcomes. There were no serious adverse events attributable to the interventions. Conclusions and Relevance This phase 2 randomized clinical trial failed to demonstrate differential benefits for online cognitive training, a structured cognitive rehabilitation program, and tDCS for cognitive long COVID. Trial Registration ClinicalTrials.gov Identifier: NCT05965739 .
Self-expanding Transcatheter vs Surgical Aortic Valve Replacement in Intermediate-Risk Patients
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Michael, Biddle, Amanda, Ernst, Dereen, Haubenschild, Julie, Howe-Clayton, Desirae, Johnson, Ramona , Mundt, Pamela, Reiter, Jacqulyn, Kutzke, Kim, Maalouf, Joseph F., Sinak, Lawrence J., Pochettino, Alberto , Sandhu, Gurpreet S. , Alkhouli, Mohamad , Best, Patricia J.M. , Bresnahan, John F., Eleid, Mackram F. , Fulgham, Jimmy R., Greason, Kevin L. , Gulati, Rajiv , Holmes, David R. , Mathew, Verghese, Meissner, Irene, Radford, Jonathan, Reeder, Guy S., Sarraf, Mohammad , Suri, Rakesh M. , Swenson, Courtney, Williams, Lindsy N., Jiang, Zuyi, Lapierre, Serge, Phan, Thi Mong Ngoc, Buithieu, Jean, Varennes, Benoît de , Piazza, Nicolo, Lachapelle, Kevin , Liam, Durcan, Martucci, Giuseppe , Blömer, Han, Herder, Wiebren, Geest, Els Van der, Wal, Metske van der, Izaksson, Rob, Kootstra, Hetty, Pultrum, Maarten, Walinga, Tamara, Boonstra, Piet W. , Boven, Adrianus J. van, Amrane, Hafid, Hofma, Sjoerd H., Schuiling, Wouter J. , Terluin, Hanny, Timmerman, Margje, Weerdt, Arno Peter van der, Vossenberg, Tessel , Barnes, Caroline , Griffin, Sandra, Marcus, Rachel , Wang, Zuyue, Widell, Jared, Bafi, Ammar S., Waksman, Ron , Choi, Joseph , Corso, Paul J., Laureno, Robert, Lin, Mark, Lowery, Robert G. , Malla, Prerna , Pichard, Augusto D., Satler, Lowell F. , Shults, Christian, Decklever, Cecily, Evans, Danika, Tuttle, Kendra, Marcus, Richard H., Chawla, Atul, Hockmuth, David, Jacoby, Michael, Jenson, Bart, McAllister, David W., Prabhakar, Ganga, Verhofste, Marnix, Morin, Colette, Potvin, Lucie, Jean, Nathalie St., Garceau, Patrick, Asgar, Anita , Cartier, Raymond , Bonan, Raoul, Dominquez, Manuel, Dorval, Jean‐François , Ibrahim, Réda , Lavoie, Marc-André, Benner, Autumn, Brunetti, Deborah, Ciprich, Christine, Lobur, Elena, Lonergan, Noele, McGlew, Suellyn, Oplinger, Jeanne, Oster, Tracy, Polise, Lucille, Purpura, Jenelle, Sentman, Susan, Zile, Catherine Van, Arogundade, Olasunkanmi, Gillan, Linda, Koulogiannis, Konstantinos , Brown, John , Kipperman, Robert, Blitz, Lawrence R., Cohen, Barry M., Généreux, Philippe , Magovern, Christopher J., Rosenberg, Richard, Safirstein, Jordan, Turner, Joanne , Xydas, Steve, Jones, Teresa, Montgomery, Susan, Kovach, Todd, Navas, Jorge A. , Lin, Lang, Rovin, Joshua D. , Arora, Ajay , Ofenloch, John C., Schneider, Jean-Raphael, Spriggs, Douglas, Stone, Lisa Cacari , Turner, Nancy J. , Basnet, Sandeep , Bhat, Arjun, Fusilero, Michael, Muthiki, Sowmya, Muthyala, Samatha, Vrestil, Nicole Saint, Sharma, Madhav , Singh, Julie , Chaudhry, Farooq A. , Sengupta, Partho P. , Sharma, Samin K. , Tang, Gilbert H.L. , Anyanwu, Anelechi, Bronster, David J., Dangas, George , Kini, Annapoorna , Stelzer, Paul, Stewart, Allan, Swain, Julie A., Annunziato, Samantha, Delliliune, Diane, Garzon, Ruby, Seeratan, Vidya, Rosman, David A., Suma, Valentin, Trost, Biana, Hartman, Alan, Katz, Stanley, Rutkin, Bruce, Boutis, Loukas, Carey, Ruthanne, DeAngelis, Teresa, DeOrchis, Vincent, Esposito, Rick, Jauhar, Rajiv , Kaplan, Barry B., Laighold, Saaron, Meraj, Perwaiz , Palazzo, Robert E., Parihar, Raminder, Podwall, David, Yu, Pey‐Jen , Abu, Miriam, Bavbekova, Saniye, Bowden, Morgan, Clark, Emily, Gaudio, Stephanie, Houanche, Pascale, Kalish, Chloe, Kapitman, Anna, Lee, Hanah, Oviedo, F. Franch, Pushkar, Illya, Robin, Tonya, Shaheen, Devin, Sin, Danielle, Taylor, Zachary , Tovar, Joseph, Daele, Jessie Van, Vidal, Samantha, Yung, Lau Yan, Jilaihawi, Hasanian, Fara, Michael , Ischida, Koto, Loulmet, Didier F., Siller, K, Staniloae, Cezar , Torres, José, Zhang, Cen , Hartlev, Christie, Huffman, Andrew, Kellum, Annie, Liptrot, Roderick, Ryan, James , Lilly, Scott , Rushing, Gregory , Grose, Noah, Lee, Vivien , Mazzaferri, Ernest L. , Mutgi, Smil, O’Neil, Susan, Perchuk, Alex, Sai‐Sudhakar, Chittoor, Slivka, Andrew , Hanes, Stacie, Banowetz, Michael, Dautenhahn, David, Mehl, Brad, Bodenhamer, Robert Mark, Ghani, Mohammad , Raikar, Goya V., Tahirkheli, Naeem , Wasemiller, Wayne, Amoroso, Elisa M , Holt, Shelley, Tucker, Claire , Martin, Randolph P., Kauten, James, Rajagopal, Vivek , Awad, Eric, Brown, W. Morris, Gott, J. Richard, Karmpaliotis, Dimitrios, Meduri, Christopher, Polsani, Venkateshwar , Rinehart, Sarah, Seiden, Lawrence, Serbanescu, Andrei, Butler, Kim D. , Elsessor, Kayla, Fehr, Brittany, Hancock, Anthony, Hollister, Regina, MacFarlane, Dawn, Rodgers, Courtney, Todd, Anita, Eubanks, Veronica, Spangler, Jessica, Wirt, Katie, Wonders, Brook, Bachinsky, William , Maini, Brijeshwar , Mumtaz, Mubashir, Aneja, Parul, Loran, David B., Shah, Jagdish, Gebhardt, Linda L., Jones, U. V., Lauterborn, Marjo, John, Henriette , Parthier, Sonja, Schaprian, Katja, Twelker, K., Nickenig, Georg, Welz, Armin, Bode, Felix J. , Fuchs, Ângela, Mellert, F, Petzold, Gabor C. , Sedaghat, Alex, Sinning, Jan‐Malte, Werner, Nikos , Bang, Helle, Brodersen, Bente Birgitte, Christensen, Pernille Roed, Eriksen, Elsebet, Groth, Susanne , Larsen, Mie Christa Jensen, Johansen, Mette Ellegaard, Lilleør, Thomas Nikolaj Bang, Larsen, Lisette Lund, Preis, Anne-Cathrine, Rieck-Broberg, Jeanette, Ihlemann, Nikolaj , Noerager, Betina, Steinbrüchel, Daniel A., Arendrup, Henrik, Franzen, Olaf, Hansen, Klaus, Højgaard, Joan , Holme, Susanne, Kjøeller, Morten, Lund, J. O., Perko, Mario J. , Sander, Kåre, Smerup, Morten , Thiis, Jens J., Thyregod, Hans Gustav Hørsted , Monnin, Kathryn, Popelas, Lori, Slyman, Martha, Grewal, Kanny, Matros, Todd, Watson, Daniel, Arshi, Arash, Blossom, Geoffrey B., Chapekis, Anthony T., Duff, Steven B., Hicks, William, Holland, Stephanie , Kander, Nathan H., Lyons, Jefferson M., Mejilla, Jennifer, Reese, Brenda, Sanchez, Carlos E. , Vora, Nirav , Erwin, Sheila, Hall, Jamie , Hayes, Natalie, Miller, Margie, Main, Michael L., Allen, Keith B. , Aggarwal, Sanjeev, Borkon, Michael, Boutwell, Christine, Davis, James R. , Grantham, Aaron, Magalski, Anthony, Olds, Karin, Buchanan, Tiffany, Daniel, Misty, Estrada, Katrina, Hollen, Matthew, Lazarsfeld-Jensen, Ann , Kennen, Jada, Bechis, Mary, Rubenson, David, Teirstein, Paul, Ahmad, Daniel, Atri, Prashant , Azarbal, Farnaz, Brewster, Scot, Brown, Christopher , Foley, T. Raymond , Groves, Elliott M. , Kalafut, Mary, Levisman, Jeffrey, Mellinger, Douglas, Odunukan, Olufunso W. , Ong, Daniel, Oyama, Jared, Panguluri, Praveen, Raney, Aidan A., Rao, Suraj, Schultz, Jason, Sharma, Alok , Stinis, Curtiss, Thompson, C. Bradley , Wadia, Subeer , Walsh, Joseph, White, Jeremy , Purrington, Elizabeth, Zulick, Chelle, Murillo, Jaime , Mahoney, Paul, Newton, Joseph, Rich, Jeffrey, Bagameri, Gabor, Dimeling, George, Jordan, Grace, Mistry, Neville F., Philpott, Jonathan M. , Sirak, John, Sourbeer, Sarah, Talreja, Deepak, Zweifler, Richard M., Helm, Elizabeth, Postema, Karen, Over, Elizabeth Van, Chilton, Dale, Mitchell, Lou, Berkompas, Duane , Fanning, Justin, Khan, Muhib , Sang, Stephane Leung Wai , Omran, Kaskar, Patzelt, Lawrence H., Thoits, Timothy , Vijayappa, Madhu, Kasle, Margie, Trautman, Leigh, Dash, Rajiv, Fischbein, Michael P. , Fearon, William F. , George, Paul V., Speight, Martina K., Tai, Waimai Amy, Albersen, Inke, Bras, Rebecca Gornelda, Feirabend, Conny, Helwig-Vernooij, Johanna Catharina, Kranen, Gerda, Oostveen, Manfred, Rost, Ilona, Deutekom, Inge van, Weelden, Atie van, Heijmen, Robin, Bosschaert, Mike Arnoud Ramon, Kroon, Thomas L. de, Hilkens, P.H.E. , Mast, Eliza G., Rensing, B. J. W. M., Schonewille, W.J., Akker, Alberta Nelina van den, Haag, Elizabeth, Jennings, Joan, Krug, Patricia, Santiago, Lyn, Seth, Sonika , Dimsuyu, Nellia, Mihalatos, Dennis, Petrossian, George , Robinson, N. Bryce , Bercow, Neil, Berke, Andrew E. , Deutsch, Ezra, Stevens, Perry, Brown, Sue, Jardim, Victor Dos Santos, Radford, Nicole, Sookhoo, Venessa, Kyereme, Kojo, Punzalan, Rachel, Sculeany, Bogdan, Brecker, Stephen , Jahangiri, Marjan , Alassa, Aiman, Chandrasekaran, Venkatachalam, Clarke, Brian , Dowling, Cameron , Moynihan, Barry, Roy, David, Sarsam, Mazin A.I., Bess, Renee, Henkel, Megan, Cohen, Gerald M., Davis, Thomas, Aboukasm, Amer, LaLonde, Thomas , Yamasaki, Hiroshi , Burkert, Marylynn, Kingma, Barbara, Wheatley, Jessica, Segar, Douglas S., Heimansohn, David, Hermiller, James, Ball, Michael, Elsner, Gregory, Hanan, Scott A., Moainie, Sina L. , Nukes, Theodore, Reibold, Patrick, Robison, Robert, Salerno, Christopher T. , Sampson, Andrew, Walts, Peter A., Wandel, Emily, Li, Mary , Sarker, Sulagna, Ahmed, Shaheeda, Radhakrishnan, Sam, Arbel, Yaron , Christakis, George T., Cohen, Gideon, Czarnecki, Andrew , Hopyan, Julia, Komatsu, Ikki , McCraig, Kathleen, Shuvy, Menashe, Toma, Jonathan, Vincenzo, Basile, Wheeler, Cindi, Wolff, Rafael , Beck, Pamela J., Cabral, Donna J., DaCosta, Christine, Hudson, Laura, Pastie, Michelle, Abrahams, Nicole, Altamar, Ingrid, Buitrago, Mike, Cassman, Gabrielle, Leibovici, Zvi, Nelson, Ana, Recchia, Kelly, Robbins, Gillian, Studor, Kelly, Bethea, Brian, Beyer, Erik, Evans, Sharron, Goodis, Caleene, Mueller‐Kronast, Nils , Pantoja, Claudia, Wells, Channing, Youngblood, Colten, Snelus, Patricia, Gopal, Deepika, Jackson, Kristie, Brown, David L. , Ryan, William H. , Gopal, Ambarish, Harrington, Katherine, Mack, Michael J. , Nosnik, Pedro, Potluri, Srinivasa , Smith, Robert L. , Szerlip, Molly, Blaylock, Candice, Brinegar, Patricia, Canter, Laura, Green, LaShawna, Green, Lisa , Hazen, Pamela, Jacobs, Amber, Khan, Saba , Ludwig, Sheryl, Mata, Mary, Moore, Tammara, Underwood, Carol , Little, Stephen H. , Nagueh, Sherif F. , Albright, Kimberly, Barker, Colin M. , Bledsoe, Donald, Chiu, David, Gray, Tiffany , Imperial-Aubin, Delmar, Lin, Chun C., Moye, Stacy, Ramchandani, Mahesh, Ramlawi, Basel , Reul, Ross M. , Reyes, Manuel, Scheinin, Scott , Volpi, John , Ballmoos, Moritz Wyler von, Blackburn, Beth, Hart, Chari Y. T., Whitacker, Pearl, Lau, Jeffrey, Spies, Christian , Badawi, Ramy A., Graner, Sarah, Nakamura, Dean, Plank, Benjamin, Salem, Rony, Seto, Todd B. , Valenta, Douglas, Cruz, Amber, Gallagher, Lauren T. , Schuck, Laura, Weeks, Andre, Fishman, Lise, Schwarz, Teresa, Bavaria, Joseph E. , Anwaruddin, Saif , Giri, Jay , Khella, Sami, Li, Robert, McGarvery, Michael, Price, R A, Szeto, Wilson Y. , Sun, Yang , Wu, Libo , Tsang, Wendy , Thavendiranathan, Dinesh, Feindel, Chris, Casaubon, Leanne K. , Cusimano, Robert J. , Campo, Martín del , Osten, Mark , Höwisch-Pengel, Rita, Lechner, Gabriele, Steiger, Barbara, Allgeier, Martin, Jander, Nikolaus , Büttner, Heinz Joachim, Comberg, Thomas, Diab, Nawras , Gick, Michael, Günkel, Ludwig, Pingpoh, Clarence , Rothe, H. Jürgen, Thoma, Martin , Winker, Thomas, Häger, Christine , Sänger, Ulrike, Stader, Michael, Biaggi, Patric , Gruner, Christiane, Binder, Ronald K. , Corti, Roberto , Holy, Erik W. , Grünenfelder, Jürg , Maier, Willibald, Nietlispach, Fabian, Atkinson, Rachel , Davis, Angela , Hall, Suzanne, Mangene, Samantha, Mazzurco, Stacey, Hoit, Brian D. , Musarra, Raymond, Markowitz, Alan , Asi, Khaled, Attizzani, Guilherme F. , Chuang, Dennis Y. , Elgudin, Yakov , Le, Scott T., Serkin, Zakhar, Shams, Tanzila, Sila, Cathy, Simon, Daniel I. , Bezerra, Hiram G. , Greening, Kyle, Karson, Jodi, Page, Susie, Shawgo, Tilitha, Freeman, Jon C., Mulhern, Kevin, Nath, Jayant , Tadros, Peter, Zorn, George L., Hockstad, Eric, Lechtenberg, Colleen, Muehlebach, Gregory, Rippee, Michael , Rosterman, Lee , Sundararajan, Jayashree, Wang, Yunxia , Wiley, Mark, Atapattu, Suresh, Kall, Christian Marin y, Lowery, Maureen H., Marchena, Eduardo de , Salerno, Tomás A. , Carillo, Roger, Ferreira, Alexandre , Williams, Donald, Bhatt, Shradha, Migda, Erin M., Oakley, Jessica, Warshal, Wendy, Wilcock, Sandra, Booher, Anna M., LaBounty, Troy , Boyle, Mary Jo, Geml, Rachel, Grossman, Paul , Guerin, Danielle, Hodges, Kelley, Lammers, Deborah, Menees, Daniel, Patel, Himanshu J. , Prager, Richard L. , Romano, Matthew, Stamper, Angela, Wang, Michael, Ziarkiewicz, Melanie, Charlebois, Cheryl, Chilton, Colleen, Labinaz, Marino , Lam, Khanh, Masters, Roy G., Steffenhagen, Nikolai, Enlow-Germovsek, Melissa, Konopka, Kristin, McGargle, Rachel, Travis, Melissa, Anderson, Kathy, Crock, Fred, Edelman, Kathy, Katz, William E. , Aghaebrahim, Amin Nima, Al-Bayai, Alhamza, Bonaccorsi, Christina, Gulati, Deepak , Henry, Lisa, Kenmuir, Cynthia L. , Klein, Bradley G., Kliner, Dustin , Limaye, Kaustubh , Nanduri, Sunanda, Navid, Forozan, Patel, Pratit , Rocha, Marcelo Borges , Schindler, John , Shoirah, Hazem , Tadi, Prasanna , Tememe, Danoushka, Totoraitis, Ruta, Walker, Greg , Ziayee, Habibullah, Caufield, Lori, Yeager, Carol, Forbes, Jennifer , Schwart, Karl Q., Knight, Peter A. , Ling, Frederick, Benesch, Curtis, Bogachan, Sahin, Hicks, George L., Kelly, Adam G. , Narins, Craig R. , Stuver, Thomas, Adams, Kathy, Blair-Anton, Lynn, Haynes, Mary Lou, Watts, Carol, Baker, Michael , Mendes, Lisa A., Kaiser, Clayton A., Robbins, Mark, Zhao, David , Ahmad, Rashid, Crenshaw, Marshall, Fredi, Joseph L., Hermann, Lisa, Hoff, Steven J. , Levack, Melissa M., Mittal, Shilpi , O’Duffy, Anne E, Petracek, Michael R., Baer, Judy, Liang, Grace , Nguyen, Son , Nguyen, Patricia K. , Burdon, Thomas A., Giacomini, John C., Yong, Celina M. , Buchbinder, Maurice , Fann, James I. , Kilgore, Shannon M., Mitchell, R. Scott, McDaniel, Sharon S., Pack, Angelina, White, Wendi, Young, Travis S. , Burgess, Pam, Pu, Min , Upadhya, Bharathi , Applegate, Robert J., Kon, Neal D., Arnan, Martinson, Baghshomali, Sanam, Bishop, L. R., Bradbury, Edward, Gandhi, Sanjay , Kincaid, Edward H., Lefkowitz, David , Lisle, Benjamin, Batteria, Melissa, Rerisi, Elizabeth, Stepinowski, Kimberly, Senicola, Tanya, Goncalves, John, Schubach, Scott , Schwartz, Richard, Antaky, Karin, Christiansen, C, Marzo, Kevin , Michel, Kathleen, Varghese, Princy , Wirkowski, Elizieta, Lévesque, Linda E. , Cleman, Michael , Forrest, John K. , Hashim, Sabet, Mangi, Abeel A. , Amin, Hardick, Darr, Umer, Dewar, Michael, Faheem, Osman, Geirsson, Arnar , Kaleel, Abdel Salam, Kaple, Ryan , Lansky, Alexandra, Grory, Brian Mac, Pfau, Steven , Schindler, Joseph , Yuh, David D., Serruys, Patrick W , Limaye, Kaustubh , Windecker, Stephan , Reardon, Michael J , Bode, Felix J , Mieghem, Nicolas M. Van , Søndergaard, Lars , Olsen, Peter Skov , Crestanello, Juan A. , George, Isaac , Serruys, Patrick W. , Williams, Mathew , Adams, David , Investigators, SURTAVI Trial, Meyer, Karen, Roberts, Dana, Sorajja, Paul , Flavin, Thomas, Gössl, Mario , Mooney, Michael R , Pendleton, Kristin, Fry, Robert, Heine, Carl, Tran, Tin, Bremer, Karen, Pieter, Jan, Verbiest, Henk, Waller, Deborah, Ahmed, Arshad , Allaqaband, Suhail Q. , Werner, Paul , Bessette, Lynn, Klein, Jason, Brady, Kevin, Chung, Steven, Franz, Douglas, Pershad, Ashish , Porter, Charlotte, Craig, John, Elijovich, Lucas , Wolf, Bradley, Wright, Lance, Roberts, Brad, Henry, Carl, Laham, Roger J. , Burke, David, Chui, Angus Shing Fung , Liu, David M. , Nathan, Senthil, Pinto, Duane S. , Searls, D. Eric, Fisher, Susan, Lim, D. Scott , Ng, Ken, Bates, Michael, Grey, William, Rose, Geoffrey, Scherer, Markus, Martin, Jerry, Cheng, Wen, Kar, Saibal , Mody, Cyrus, Ramzy, Danny , Sohn, Jeanie, Hahn, Rebecca T , Contreras, Jose Gutierrez, Kummer, Benjamin R. , Miller, Eliza C. , Nazif, Tamim , Qureshi, Abid, Rostanski, Sara , Willey, Joshua , Yaghi, Shadi , Rosenbloom, Michael, Schell, Wendy, Huang, Hong , Ali, Omar, Henry, Scott, Bleiziffer, Sabine , Hengstenberg, Christian , Brenner, Susanne, Kasel, Albert Markus , Kreuzpointner, Robert , Poppert, Holger , Seifert, Christian, Voß, Bernhard , Cowhig, Dahlia, Newbold, Stephanie, Velazquez, Eric J. , Harrison, J. Kevin, Hughes, George Chad , Ali, Yasmin, Gokhale, Sankalp , Hendry, Robert, Hernandez, Christian, Klein, Michael, Kolls, Brad J. , Maldonado, Andres M. Pineda, Price, Andrew James , Sherwood, Matthew W. , Swisher, Christa B. , Wang, Andrew , Lamm, Janet, Schroeder, Ryan, De, Ajanta, Charles, Elizabeth, Wheeler, Lauren, Merlino, John , Greene, James, Harrison, Amy, Leshnower, Bradley G. , Miller, Jeffrey S. , Nahab, Fadi B , Stewart, James, Kappetein, A. 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JAMA Cardiology | August 24, 2022 | Volume: 7 | Issue: 10 | Pages: 1000
Importance In patients with severe aortic valve stenosis at intermediate surgical risk, transcatheter aortic valve replacement (TAVR) with a self-expanding supra-annular valve was noninferior to surgery for all-cause mortality or disabling stroke at 2 years. Comparisons of longer-term clinical and hemodynamic outcomes in these patients are limited. Objective To report prespecified secondary 5-year outcomes from the Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement (SURTAVI) randomized clinical trial. Design, Setting, and Participants SURTAVI is a prospective randomized, unblinded clinical trial. Randomization was stratified by investigational site and need for revascularization determined by the local heart teams. Patients with severe aortic valve stenosis deemed to be at intermediate risk of 30-day surgical mortality were enrolled at 87 centers from June 19, 2012, to June 30, 2016, in Europe and North America. Analysis took place between August and October 2021. Intervention Patients were randomized to TAVR with a self-expanding, supra-annular transcatheter or a surgical bioprosthesis. Main Outcomes and Measures The prespecified secondary end points of death or disabling stroke and other adverse events and hemodynamic findings at 5 years. An independent clinical event committee adjudicated all serious adverse events and an independent echocardiographic core laboratory evaluated all echocardiograms at 5 years. Results A total of 1660 individuals underwent an attempted TAVR (n = 864) or surgical (n = 796) procedure. The mean (SD) age was 79.8 (6.2) years, 724 (43.6%) were female, and the mean (SD) Society of Thoracic Surgery Predicted Risk of Mortality score was 4.5% (1.6%). At 5 years, the rates of death or disabling stroke were similar (TAVR, 31.3% vs surgery, 30.8%; hazard ratio, 1.02 [95% CI, 0.85-1.22]; P = .85). Transprosthetic gradients remained lower (mean [SD], 8.6 [5.5] mm Hg vs 11.2 [6.0] mm Hg; P < .001) and aortic valve areas were higher (mean [SD], 2.2 [0.7] cm 2 vs 1.8 [0.6] cm 2 ; P < .001) with TAVR vs surgery. More patients had moderate/severe paravalvular leak with TAVR than surgery (11 [3.0%] vs 2 [0.7%]; risk difference, 2.37% [95% CI, 0.17%- 4.85%]; P = .05). New pacemaker implantation rates were higher for TAVR than surgery at 5 years (289 [39.1%] vs 94 [15.1%]; hazard ratio, 3.30 [95% CI, 2.61-4.17]; log-rank P < .001), as were valve reintervention rates (27 [3.5%] vs 11 [1.9%]; hazard ratio, 2.21 [95% CI, 1.10-4.45]; log-rank P = .02), although between 2 and 5 years only 6 patients who underwent TAVR and 7 who underwent surgery required a reintervention. Conclusions and Relevance Among intermediate-risk patients with symptomatic severe aortic stenosis, major clinical outcomes at 5 years were similar for TAVR and surgery. TAVR was associated with superior hemodynamic valve performance but also with more paravalvular leak and valve reinterventions.