In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.

We use cookies to optimise the design of this website and make continuous improvement. By continuing your visit, you consent to the use of cookies. Learn more

Transcatheter vs surgical aortic valve replacement in intermediate-surgical-risk patients with aortic stenosis:

A propensity score–matched case-control study

Background


Limited real-world data comparing outcomes after transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in intermediate-surgical-risk patients with aortic stenosis are available.
Valvular Heart Diseases


Methods

We identified 182 consecutive patients who underwent TAVR via the transfemoral (TF) route (November 2007–February 2011) and 111 moderate-to-high-risk historical case controls undergoing SAVR (August 2003–July 2008). Using propensity score matching based on clinical characteristics and surgical risk scores, we compared clinical outcomes in 111 matched patients. Valve Academic Research Consortium definitions were applied for end point adjudication.

Results

Baseline clinical characteristics, in particular Logistic European System for Cardiac Operative Risk Evaluation (23.2 ± 15.1 vs 24.4 ± 13.4) and Society of Thoracic Surgeons score (4.6 ± 2.3 vs 4.6 ± 2.6), were well matched between groups. Transfemoral TAVR was associated with more vascular complications (33.3% vs 0.9%, P < .001). On the other hand, acute kidney injury was more frequent after SAVR (8.1% vs 26.1%, P < .001). The rates of all-cause mortality in both TF-TAVR and SAVR groups was1.8% at 30 days (P = 1.00) and 6.4% and 8.1%, respectively, at 1 year (P = .80). At 1 year, the rate of cerebrovascular events was similar in the 2 groups (4.6% vs 9.1%, P = .19).

Conclusion:


In this real-world cohort of intermediate-surgical-risk patients with aortic stenosis, TF-TAVR and SAVR were associated with similar mortality rates during follow-up but with a different spectrum of periprocedural complications. Furthermore, the survival rate after TF-TAVR in this group of elderly patients with intermediate Society of Thoracic Surgeons score was encouraging.

Notes to editor


Azeem Latib, Francesco Maisano, Letizia Bertoldi, Andrea Giacomini, Joanne Shannon, Micaela Cioni, Alfonso Ielasi, Filippo Figini, Kensuke Tagaki, Annalisa Franco, Remo Daniel Covello, Antonio Grimaldi, Pietro Spagnolo, Gill Louise Buchannan, Mauro Carlino, Alaide Chieffo, Matteo Montorfano, Ottavio Alfieri, Antonio Colombo
American Heart Journal - Original Research Article - Pages 910-917

 

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.