Background
Previous trials have shown that, among high-risk patients with aortic stenosis, survival
rates are similar for transcatheter aortic-valve implantation (TAVI) and surgical
aortic valve replacement. The study aimed to compare the outcomes of aortic valve
replacement according to the adopted surgical approach in intermediate and low risk
patients.
Methods
This is a retrospective, observational, cohort study of prospectively collected data
from 421 patients undergoing isolated aortic valve replacement between 2011 and 2015.
A multinomial logit propensity score model based on preoperative risk factors was
used to match patients 1:1:1 between conventional replacement (CAVR), minimally invasive
(MIAVR) and TAVI groups, resulting in 50 matched three cohorts.
Results
After multinomial logit propensity score, the three groups were comparable in terms
of preoperative characteristics. Mean age and Logistic EuroSCORE I of CAVR, MIAVR
and TAVI groups were (84.2 ± 5.1 vs. 82.3 ± 4.8 vs. 85.6 ± 4.9 years; p = 0.002) and (11.4 ± 3.6% vs. 8.3 ± 3.4% vs. 15.8 ± 5.4%; p < 0.001) respectively. Overall mortality rates were similar for the three patient cohorts
at one year. There were no significant differences related to stroke to 30 days. In
the TAVI cohort, pacemaker implantation for new-onset total atrioventricular block
became necessary in 30% of patients (p < 0.001) and 16% of patients had some degree of paravalvular aortic regurgitation, which
was more than mild (p < 0.001). Total length of stay was shorter in the TAVI group when compared with surgical
groups (11.5 ± 5.3 vs. 10.1 ± 6.9 vs 8.5 ± 3.7 days; p = 0.023). After discharge, the survival rate follow-up (average follow up: 46.7 months)
was 70%, 84% and 72% for three cohorts (log Rank x2 = 2.40, p = 0.3).
Conclusions
In our experience, the three aortic valve replacement approaches offer very good results.
Differences in the rate of complications were found between groups. Depending on patient’s
characteristics the Heart-Team group must offer the best surgical approach for each
patient.
Keywords
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Article info
Publication history
Published online: September 06, 2017
Accepted:
August 8,
2017
Received:
February 17,
2017
Identification
Copyright
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
