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Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, Thourani VH, Tuzcu EM, Miller DC, Herrmann HC, Doshi D, Cohen DJ, Pichard AD, Kapadia S, Dewey T, Babaliaros V, Szeto WY, Williams MR, Kereiakes D, Zajarias A, Greason KL, Whisenant BK, Hodson RW, Moses JW, Trento A, Brown DL, Fearon WF, Pibarot P, Hahn RT, Jaber WA, Anderson WN, Alu MC, Webb JG. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med 2016; 374:1609-20. [PMID: 27040324 DOI: 10.1056/nejmoa1514616] [Citation(s) in RCA: 3574] [Impact Index Per Article: 446.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Previous trials have shown that among high-risk patients with aortic stenosis, survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve replacement. We evaluated the two procedures in a randomized trial involving intermediate-risk patients. METHODS We randomly assigned 2032 intermediate-risk patients with severe aortic stenosis, at 57 centers, to undergo either TAVR or surgical replacement. The primary end point was death from any cause or disabling stroke at 2 years. The primary hypothesis was that TAVR would not be inferior to surgical replacement. Before randomization, patients were entered into one of two cohorts on the basis of clinical and imaging findings; 76.3% of the patients were included in the transfemoral-access cohort and 23.7% in the transthoracic-access cohort. RESULTS The rate of death from any cause or disabling stroke was similar in the TAVR group and the surgery group (P=0.001 for noninferiority). At 2 years, the Kaplan-Meier event rates were 19.3% in the TAVR group and 21.1% in the surgery group (hazard ratio in the TAVR group, 0.89; 95% confidence interval [CI], 0.73 to 1.09; P=0.25). In the transfemoral-access cohort, TAVR resulted in a lower rate of death or disabling stroke than surgery (hazard ratio, 0.79; 95% CI, 0.62 to 1.00; P=0.05), whereas in the transthoracic-access cohort, outcomes were similar in the two groups. TAVR resulted in larger aortic-valve areas than did surgery and also resulted in lower rates of acute kidney injury, severe bleeding, and new-onset atrial fibrillation; surgery resulted in fewer major vascular complications and less paravalvular aortic regurgitation. CONCLUSIONS In intermediate-risk patients, TAVR was similar to surgical aortic-valve replacement with respect to the primary end point of death or disabling stroke. (Funded by Edwards Lifesciences; PARTNER 2 ClinicalTrials.gov number, NCT01314313.).
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Affiliation(s)
- Martin B Leon
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Craig R Smith
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Michael J Mack
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Raj R Makkar
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Lars G Svensson
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Susheel K Kodali
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Vinod H Thourani
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - E Murat Tuzcu
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - D Craig Miller
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Howard C Herrmann
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Darshan Doshi
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - David J Cohen
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Augusto D Pichard
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Samir Kapadia
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Todd Dewey
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Vasilis Babaliaros
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Wilson Y Szeto
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Mathew R Williams
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Dean Kereiakes
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Alan Zajarias
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Kevin L Greason
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Brian K Whisenant
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Robert W Hodson
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Jeffrey W Moses
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Alfredo Trento
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - David L Brown
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - William F Fearon
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Philippe Pibarot
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Rebecca T Hahn
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Wael A Jaber
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - William N Anderson
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Maria C Alu
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - John G Webb
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
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