Transcatheter aortic valve implantation versus surgical aortic valve replacement in low-risk patients: a propensity score-matched analysis. (30th September 2019)

• Record Type: Journal Article
• Authors: Schaefer, Andreas; Schofer, Niklas; Goßling, Alina; Seiffert, Moritz; Schirmer, Johannes; Deuschl, Florian; Schneeberger, Yvonne; Voigtländer, Lisa; Detter, Christian; Schaefer, Ulrich; Blankenberg, Stefan; Reichenspurner, Hermann; Conradi, Lenard; Westermann, Dirk
• Is Part Of: European journal of cardio-thoracic surgery. Volume 56:Number 6(2019)
• Page Start: 1131
• Page End: 1139
• Publication Date: 2019-09-30
• Subjects: Transcatheter aortic valve implantation -- Surgical aortic valve replacement -- Paravalvular leakage -- Permanent pacemaker implantation; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezz245
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: The aim of the study was to determine the differences in outcomes of surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) in low-risk patients. METHODS: All patients with a logistic EuroSCORE II <4% who underwent transfemoral TAVI between 2008 and 2016 ( n = 955) or SAVR between 2009 and 2014 ( n = 886) at our centre were included. One hundred and nine patients per group were available for propensity score matching. RESULTS: Mortality during the 30-day follow-up showed no differences (SAVR vs TAVI: 1.1% vs 1.8%, P = 1.0) but the rates of permanent pacemaker implantation (0.0 vs 14.8%, P < 0.001) and paravalvular leakage ≥ moderate (0.0 vs 7.0%, P = 0.017) were higher in TAVI patients. No difference was found regarding postoperative effective orifice area and transvalvular pressure gradients. Although, the 1-year survival was similar between both groups; 3- and 5-year survival was significantly inferior in the TAVI patient cohort. CONCLUSIONS: TAVI yielded similar short-term outcomes compared with SAVR despite higher rates of permanent pacemaker implantation and paravalvular leakage ≥ moderate, but inferior long-term survival. Poorer long-term outcomes of the TAVI patient cohort were attributable to a more comorbid TAVI population. This emphasizes the need for long-term results from randomized controlled trials before TAVI can be broadly expanded to younger low-risk patients.