Background
Since the last formal publication reporting on the findings of the Australian and
New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) database on surgical
aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR)
in 2016, transcatheter approaches have become common practice. There has been an increase
in use of TAVR following large, randomised control trials that only report on short-term
outcomes in a selective cohort. This study aims to report on primary outcome measures
and identify complications associated with SAVR and TAVR from a large national database.
Methods
From the ANZSCTS database (2001–19), 14,097 SAVR and 1,194 TAVR patients were identified
with clinical details and 30-day follow-up available. The primary endpoint was the
composite of all-cause mortality and/or permanent stroke at 30 days. Secondary endpoints
were post-procedure complications requiring treatment. Logistical regression followed
by propensity score matching was performed.
Results
Using logistical regression when all patient factors considered for all patients who
had SAVR and TAVR, the only preoperative factors that had an impact on 30-day mortality
was cerebrovascular disease, respiratory disease, preoperative dialysis, angina, and
hypertension. Primary outcome 30-day mortality rate was 1.83% in the SAVR group, and
1.68% in patients in the TAVR group, p=0.7001, and permanent stroke was seen in 1.07%
patients in the SAVR group, and 1.26% patients in the TAVR group. Acute limb ischaemia,
aortic dissection, ventricular tachycardia, bradyarrhythmia and heart block were more
common following TAVR (p<0.001), while reintubation and atrial arrhythmia were more
common following SAVR (p<0.001).
Conclusions
In the real world SAVR and TAVR have been used in very different patient groups and
it is difficult to compare as different baseline characteristics and complications.
The two patient groups maintain similarities in primary and secondary endpoints, but
differences in life threatening and life altering morbidity remains significant. Collection
of SAVR and TAVR data in a combined database may help to better capture and compare
these complications and institute strategies to prevent them.
Keywords
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Article info
Publication history
Published online: May 13, 2022
Accepted:
April 11,
2022
Received in revised form:
April 5,
2022
Received:
December 25,
2021
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.
ScienceDirect
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- Leaflet Immobility and Hypo-Attenuated Leaflet Thrombosis (HALT)–Under-Recognised Complications of Bioprosthetic Valve ReplacementsHeart, Lung and CirculationVol. 31Issue 8
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