Long-term survival after surgical or transcatheter aortic valve replacement for low or intermediate surgical risk aortic stenosis: Comparison with general population. Issue 1 (January 2023)

• Record Type: Journal Article
• Authors: Maeda, Shusaku; Toda, Koichi; Shimamura, Kazuo; Yoshioka, Daisuke; Maeda, Koichi; Yamada, Yu; Igeta, Masataka; Sakata, Yasushi; Sawa, Yoshiki; Miyagawa, Shigeru
• Is Part Of: Journal of cardiology. Volume 81:Issue 1(2023)
• Page Start: 68
• Page End: 75
• Publication Date: 2023-01
• Subjects: Trans-catheter aortic valve implantation -- Choice of intervention -- Long-term outcome -- Real-world population; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2022.08.003
• Languages: English
• ISSNs: 0914-5087

Abstract

Abstract: Background: Long-term survival after surgery for severe aortic stenosis (AS) provides important information regarding the choice between surgical (SAVR) and transcatheter (TAVR) aortic valve replacement. This study investigated the long-term survival of AS patients with low or intermediate surgical risk who underwent SAVR or TAVR in our institution versus that of the Japanese general population. Methods: From 2009 to 2019, 1276 consecutive patients underwent SAVR or TAVR for severe AS. Among them, we retrospectively investigated those with low ( n = 383) or intermediate ( n = 137) surgical risk treated with SAVR and those with low ( n = 86) or intermediate ( n = 333) surgical risk treated with TAVR. Their post-intervention survival was compared with that of an age- and gender-matched Japanese general population. Results: The overall 5-year survival rate of SAVR for patients with low surgical risk (mean age, 72 ± 9 years) was not significantly different from that of the general population (90 % vs. 89 %, respectively; p = 0.58), whereas that of patients with intermediate surgical risk (77 ± 6 years) was significantly lower than that of the general population (77 % vs. 84 %, respectively; p = 0.03). After TAVR, the 5-year survival of patients with low (78 ± 8 years) or intermediate (83 ± 5 years) surgical risk was significantly lower than that of the general population (low risk, 64 % vs. 81 %, p < 0.01; intermediate risk, 66 % vs. 71 %, respectively, p = 0.01). Conclusions: Our study demonstrated that long-term survival after SAVR for AS patients with low surgical risk was as good as that of the age- and gender-matched general population, while the long-term survival after SAVR for intermediate-risk or TAVR for low- or intermediate-risk patients was lower than that of the general population. These findings suggest that SAVR is an appropriate option for AS patients with low surgical risk and good life expectancy, especially in Japan, where the life expectancy is the longest worldwide. Graphical abstract: Unlabelled Image Highlights: Long-term data after SAVR or TAVR for AS are still lacking in Japan. Long-term survival after surgery was compared with that of the general population. Survival after SAVR for low surgical risk AS was similar with the general population. SAVR seems to be a better option for low risk AS with good life expectancy.