TY - JOUR
T1 - Surgical versus transcatheter aortic valve replacement in low-risk patients
T2 - A long-term propensity score-matched analysis
AU - Brízido, Catarina
AU - Madeira, Márcio
AU - Brito, João
AU - Madeira, Sérgio
AU - Campante Teles, Rui
AU - Raposo, Luís
AU - Mesquita Gabriel, Henrique
AU - Nolasco, Tiago
AU - de Araújo Gonçalves, Pedro
AU - Sousa-Uva, Miguel
AU - Abecasis, Miguel
AU - de Sousa Almeida, Manuel
AU - Neves, José Pedro
AU - Mendes, Miguel
N1 - Funding Information:
The authors would like to thank Dr. João Carmo, MD, who was responsible for the propensity score analysis. We would also like to thank Dr. Christopher Strong, MD, Dr. Daniel Matos, MD, Dr. Mariana Gonçalves, MD, Dr. Afonso Félix de Oliveira, MD, Dr. Cláudia Silva, MD, Dr. Francisco Gama, MD, and Dr. Gustavo Sá Mendes, MD, who contributed to data collection. Finally, we would like to thank Dr. Marta Marques, MD, Dr. Sérgio Boshoff, MD, Dr. Luís Bruges, MD, and Dr. José Calquinha, MD, for patient evaluation and surgical treatment.
Publisher Copyright:
© 2021 Wiley Periodicals LLC.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Background: Recent studies suggest the use of transcatheter aortic valve implantation (TAVI) as an alternative to surgical aortic valve replacement (SAVR) in lower risk populations, but real-world data are scarce. Methods: Single-center retrospective study of patients undergoing SAVR (between June 2009 and July 2016, n = 682 patients) or TAVI (between June 2009 and July 2017, n = 400 patients). Low surgical risk was defined as EuroSCORE II (ES II) < 4% for single noncoronary artery bypass graft procedure. TAVI patients were propensity score-matched in a 1:1 ratio with SAVR patients, paired by age, New York Heart Association class, diabetes mellitus, chronic obstructive pulmonary disease, atrial fibrillation, creatinine clearance, and left ventricular ejection fraction < 50%. Results: A total of 158 patients (79 SAVR and 79 TAVI) were matched (mean age 79 ± 6 years, 79 men). TAVI patients had a higher incidence of permanent pacemaker implantation (0% vs. 19%, p < 0.001) and more than mild paravalvular leak (4% vs. 18%, p = 0.009), but comparable rates of stroke, major or life-threatening bleeding, emergent cardiac surgery, new-onset atrial fibrillation, and need for renal replacement therapy. Hospital length-of-stay and 30-day mortality were similar. At a median follow-up of 4.5 years (IQR 3.0–6.9), treatment strategy did not influence all-cause mortality (HR 1.19, 95% CI 0.77–1.83, log rank p = 0.43) nor rehospitalization (crude subdistribution HR 1.56, 95% CI 0.71–3.41, p = 0.26). ES II remained the only independent predictor of long-term all-cause mortality (adjusted HR 1.40, 95% CI 1.04–1.90, p = 0.029). Conclusion: In this low surgical risk severe aortic stenosis population, we observed similar rates of 30-day and long-term all-cause mortality, despite higher rates of permanent pacemaker implantation and more than mild paravalvular leak in TAVI patients. The results of this small study suggest that both procedures are safe and effective in the short-term, while the Heart Team remains essential to assess both options on the long-term.
AB - Background: Recent studies suggest the use of transcatheter aortic valve implantation (TAVI) as an alternative to surgical aortic valve replacement (SAVR) in lower risk populations, but real-world data are scarce. Methods: Single-center retrospective study of patients undergoing SAVR (between June 2009 and July 2016, n = 682 patients) or TAVI (between June 2009 and July 2017, n = 400 patients). Low surgical risk was defined as EuroSCORE II (ES II) < 4% for single noncoronary artery bypass graft procedure. TAVI patients were propensity score-matched in a 1:1 ratio with SAVR patients, paired by age, New York Heart Association class, diabetes mellitus, chronic obstructive pulmonary disease, atrial fibrillation, creatinine clearance, and left ventricular ejection fraction < 50%. Results: A total of 158 patients (79 SAVR and 79 TAVI) were matched (mean age 79 ± 6 years, 79 men). TAVI patients had a higher incidence of permanent pacemaker implantation (0% vs. 19%, p < 0.001) and more than mild paravalvular leak (4% vs. 18%, p = 0.009), but comparable rates of stroke, major or life-threatening bleeding, emergent cardiac surgery, new-onset atrial fibrillation, and need for renal replacement therapy. Hospital length-of-stay and 30-day mortality were similar. At a median follow-up of 4.5 years (IQR 3.0–6.9), treatment strategy did not influence all-cause mortality (HR 1.19, 95% CI 0.77–1.83, log rank p = 0.43) nor rehospitalization (crude subdistribution HR 1.56, 95% CI 0.71–3.41, p = 0.26). ES II remained the only independent predictor of long-term all-cause mortality (adjusted HR 1.40, 95% CI 1.04–1.90, p = 0.029). Conclusion: In this low surgical risk severe aortic stenosis population, we observed similar rates of 30-day and long-term all-cause mortality, despite higher rates of permanent pacemaker implantation and more than mild paravalvular leak in TAVI patients. The results of this small study suggest that both procedures are safe and effective in the short-term, while the Heart Team remains essential to assess both options on the long-term.
KW - Aortic valve disease
KW - Percutaneous intervention
KW - Surgery
KW - Transcatheter valve implantation
KW - Valvular
UR - http://www.scopus.com/inward/record.url?scp=85114898278&partnerID=8YFLogxK
U2 - 10.1002/ccd.29948
DO - 10.1002/ccd.29948
M3 - Article
C2 - 34506074
AN - SCOPUS:85114898278
SN - 1522-1946
VL - 98
SP - E1033-E1043
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 7
ER -
