***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES This study sought to examine sex-specific differences in outcomes after surgical aortic valve replacement ( SAVR ) or transcatheter aortic valve replacement ( TAVR ) in high-risk patients with severe aortic stenosis . BACKGROUND The PARTNER ( Placement of Aortic Transcatheter Valve ) trial demonstrated similar 2-year survival with SAVR or TAVR for high-risk patients , but sex-specific outcomes are unknown . METHODS In all , 699 patients ( 300 female ) were r and omly assigned 1:1 to either SAVR or TAVR with a balloon exp and able pericardial tissue valve . Baseline characteristics and 2-year outcomes of TAVR versus SAVR were compared among males and females . RESULTS Baseline characteristics differed between the sexes . Despite higher Society of Thoracic Surgeons mortality risk scores ( 11.9 vs. 11.6 ; p = 0.05 ) , female patients had lower prevalence of coronary artery disease ( 64.4 % vs. 83.7 % ) , prior coronary artery bypass graft surgery ( 19.8 % vs. 61.2 % ) , peripheral vascular disease ( 36.4 % vs. 46.9 % ) , diabetes mellitus ( 35.6 % vs. 45.6 % ) , and elevated creatinine ( 11.7 % vs. 23.9 % ) . Among female patients , procedural mortality trended lower with TAVR versus SAVR ( 6.8 % vs. 13.1 % ; p = 0.07 ) and was maintained throughout follow-up ( hazard ratio [ HR ] : 0.67 ; 95 % confidence interval [ CI ] : 0.44 to 1.00 ; p = 0.049 ) , driven by the transfemoral arm ( HR : 0.55 ; 95 % CI : 0.32 to 0.93 ; p = 0.02 ) . Among male patients , although procedural mortality was lower with TAVR ( 6 % vs. 12.1 % ; p = 0.03 ) , there was no overall survival benefit ( HR : 1.15 ; 95 % CI : 0.82 to 1.61 ; p = 0.42 ) . CONCLUSIONS In this retrospective sub analysis of high-risk , symptomatic aortic stenosis patients in the PARTNER trial , female subjects had lower late mortality with TAVR versus SAVR . This was especially true among patients suitable for transfemoral access and suggests that TAVR may be preferred over surgery for high-risk female patients . A r and omized , controlled trial conducted specifically in female patients is necessary to properly study differences in mortality between treatment modalities . ( THE PARTNER TRIAL : Placement of AoRTic TraNscathetER Valve Trial ; NCT00530894 ) BACKGROUND The use of transcatheter aortic-valve replacement has been shown to reduce mortality among high-risk patients with aortic stenosis who are not c and i date s for surgical replacement . However , the two procedures have not been compared in a r and omized trial involving high-risk patients who are still c and i date s for surgical replacement . METHODS At 25 centers , we r and omly assigned 699 high-risk patients with severe aortic stenosis to undergo either transcatheter aortic-valve replacement with a balloon-exp and able bovine pericardial valve ( either a transfemoral or a transapical approach )  or surgical replacement .  The primary end point was death from any cause at 1 year . The primary hypothesis was that transcatheter replacement is not inferior to surgical replacement . RESULTS The rates of death from any cause were 3.4 % in the transcatheter group and 6.5 % in the surgical group at 30 days ( P=0.07 ) and 24.2 % and 26.8 % , respectively , at 1 year ( P=0.44 ) , a reduction of 2.6 percentage points in the transcatheter group ( upper limit of the 95 % confidence interval , 3.0 percentage points ; predefined margin , 7.5 percentage points ; P=0.001 for noninferiority ) . The rates of major stroke were 3.8 % in the transcatheter group and 2.1 % in the surgical group at 30 days ( P=0.20 ) and 5.1 % and 2.4 % , respectively , at 1 year ( P=0.07 ) . At 30 days , major vascular complications were significantly more frequent with transcatheter replacement ( 11.0 % vs. 3.2 % , P<0.001 ) ; adverse events that were more frequent after surgical replacement included major bleeding ( 9.3 % vs. 19.5 % , P<0.001 ) and new-onset atrial fibrillation ( 8.6 % vs. 16.0 % , P=0.006 ) . More patients undergoing transcatheter replacement had an improvement in symptoms at 30 days , but by 1 year , there was not a significant between-group difference . CONCLUSIONS In high-risk patients with severe aortic stenosis , transcatheter and surgical procedures for aortic-valve replacement were associated with similar rates of survival at 1 year , although there were important differences in periprocedural risks . ( Funded by Edwards Lifesciences ; Clinical Trials.gov number , NCT00530894 . ) OBJECTIVES We compared the incidence of prosthesis-patient mismatch ( PPM ) between  transcatheter aortic valve replacement ( TAVR )  using a self-exp and ing bioprosthesis and surgical aortic valve replacement ( SAVR ) in the CoreValve US High Risk Pivotal Trial . We sought to determine the influence of PPM on clinical outcomes . METHODS Patients with severe aortic stenosis and at increased risk for surgery were r and omized 1:1 to TAVR or SAVR .  Postoperative PPM was defined by the effective orifice area index ( EOAi ) as severe PPM ( EOAi ≤ 0.65 cm(2)/m(2 ) ) and no severe PPM ( EOAi > 0.65 cm(2)/m(2 ) ) ; clinical outcomes were analyzed in the TAVR arm ( n = 389 ) and SAVR arm ( n = 353 ) . Left ventricular mass index and regression were analyzed at baseline and 1 year . RESULTS The incidence of severe PPM in the SAVR group at 1 year was 25.7 % versus 6.2 % in the TAVR group ( P < .0001 ) . Left ventricular mass index regression at 1 year was 6.8 % for TAVR and 15.1 % for SAVR in patients with severe PPM . At 1 year the rate of all-cause mortality and acute kidney injury were significantly greater in all patients ( TAVR + SAVR ) with severe PPM compared with no severe PPM ( 20.6 % vs 12.0 % [ P = .0145 ] for death and 19.2 % vs 8.5 % [ P = .0008 ] for acute kidney injury ) . CONCLUSIONS In patients with high surgical risk and severe aortic stenosis , severe PPM is more common in patients treated with SAVR than those treated with TAVR . Patients with severe PPM are a greater risk for death and acute kidney injury than patients without severe PPM OBJECTIVES This study sought to compare health status and quality -of-life outcomes for patients with severe aortic stenosis ( AS ) and high surgical risk treated with either transcatheter aortic valve replacement ( TAVR ) or surgical aortic valve replacement ( AVR ) .  BACKGROUND For high-risk patients with severe AS , TAVR has been shown to result in similar 12-month survival but differing adverse events compared with AVR . METHODS We evaluated the health status of 628 patients with severe , symptomatic AS at high risk of surgical complications who were r and omized to either TAVR or AVR in the PARTNER Trial .  Health status was assessed at baseline and 1 , 6 , and 12 months using the Kansas City Cardiomyopathy Question naire , the Short Form-12 , and the EuroQol-5D . RESULTS The primary outcome , the Kansas City Cardiomyopathy Question naire summary score , improved more rapidly with TAVR , but was similar for the 2 groups at 6 and 12 months . However , there was a significant interaction between the benefit of TAVR and access site ( transapical vs. transfemoral ) . Patients eligible for transfemoral TAVR demonstrated significant health status benefits with TAVR versus AVR at 1 month ( difference , 9.9 points ; 95 % confidence interval : 4.9 to 14.9 ; p < 0.001 ) , whereas patients treated via the TA approach demonstrated no benefits with TAVR compared with AVR at any time point . Results for Kansas City Cardiomyopathy Question naire subscales and generic measures demonstrated similar patterns . CONCLUSIONS In high-risk patients with severe AS , health status improved substantially between baseline and 1 year after either TAVR or AVR . TAVR via the transfemoral , but not the transapical route , was associated with a short-term advantage compared with surgery . ( Placement of AoRTic TraNscathetER Valve [ PARTNER ] trial ; NCT00530894 ) BACKGROUND We compared transcatheter aortic-valve replacement ( TAVR ) , using a self-exp and ing transcatheter aortic-valve bioprosthesis , with surgical aortic-valve replacement in patients with severe aortic stenosis and an increased risk of death during surgery . METHODS We recruited patients with severe aortic stenosis who were at increased surgical risk as determined by the heart team at each study center . Risk assessment included the Society of Thoracic Surgeons Predictor Risk of Mortality estimate and consideration of other key risk factors . Eligible patients were r and omly assigned in a 1:1 ratio to TAVR with the self-exp and ing transcatheter valve ( TAVR group ) or to surgical aortic-valve replacement ( surgical group ) . The primary end point was the rate of death from any cause at 1 year , evaluated with the use of both noninferiority and superiority testing . RESULTS A total of 795 patients underwent r and omization at 45 centers in the United States . In the as-treated analysis , the rate of death from any cause at 1 year was significantly lower in the TAVR group than in the surgical group ( 14.2 % vs. 19.1 % ) , with an absolute reduction in risk of 4.9 percentage points ( upper boundary of the 95 % confidence interval , -0.4 ; P<0.001 for noninferiority ; P = 0.04 for superiority ) . The results were similar in the intention-to-treat analysis . In a hierarchical testing procedure , TAVR was noninferior with respect to echocardiographic indexes of valve stenosis , functional status , and quality of life . Exploratory analyses suggested a reduction in the rate of major adverse cardiovascular and cerebrovascular events and no increase in the risk of stroke . CONCLUSIONS In patients with severe aortic stenosis who are at increased surgical risk , TAVR with a self-exp and ing transcatheter aortic-valve bioprosthesis was associated with a significantly higher rate of survival at 1 year than surgical aortic-valve replacement . ( Funded by Medtronic ; U.S. CoreValve High Risk Study Clinical Trials.gov number , NCT01240902 . ) Background —The Placement of Aortic Transcatheter Valves ( PARTNER ) trial demonstrated similar survival after transcatheter and surgical aortic valve replacement ( TAVR and SAVR , respectively ) in high-risk patients with symptomatic , severe aortic stenosis . The aim of this study was to evaluate the effect of left ventricular ( LV ) dysfunction on clinical outcomes after TAVR and SAVR and the impact of aortic valve replacement technique on LV function . Methods and Results —The PARTNER trial r and omized high-risk patients with severe aortic stenosis to TAVR or SAVR .  Patients were stratified by the presence of LV ejection fraction ( LVEF ) < 50 % . All-cause mortality was similar for TAVR and SAVR at 30-days and 1 year regardless of baseline LV function and valve replacement technique . In patients with LV dysfunction , mean LVEF increased from 35.7±8.5 % to 48.6±11.3 % ( P<0.0001 ) 1 year after TAVR and from 38.0±8.0 % to 50.1±10.8 % after SAVR ( P<0.0001 ) . Higher baseline LVEF ( odds ratio , 0.90 [ 95 % confidence interval , 0.86 , 0.95 ] ; P<0.0001 ) and previous permanent pacemaker ( odds ratio , 0.34 [ 95 % confidence interval , 0.15 , 0.81 ] ) were independently associated with reduced likelihood of ≥10 % absolute LVEF improvement by 30 days ; higher mean aortic valve gradient was associated with increased odds of LVEF improvement ( odds ratio , 1.04 per 1 mm Hg [ 95 % confidence interval , 1.01 , 1.08 ] ) . Failure to improve LVEF by 3 
    Output:
    
Conclusions Symptomatic aortic stenosis can be lethal without intervention but surgical resection is contraindicated for some patients and high risk for others .
We found that all-cause mortality up to 5 years of follow-up did not differ significantly between TAVI and SAVR in patients surgically operable at a high risk , but favoured TAVI over medical therapy in patients surgically inoperable .
TAVI is a viable life-extending treatment option in these surgical high risk groups