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J Thorac Cardiovasc Surg. 2014 Feb;147(2):561-7. doi: 10.1016/j.jtcvs.2013.10.025. Epub 2013 Nov 23.

Sutureless replacement versus transcatheter valve implantation in aortic valve stenosis: a propensity-matched analysis of 2 strategies in high-risk patients.

Author information

1
Department of Cardiac Surgery, Klinikum Nürnberg, Nürnberg, Germany. Electronic address: g.santarpino@libero.it.
2
Department of Cardiac Surgery, Klinikum Nürnberg, Nürnberg, Germany.
3
Department of Cardiology, Klinikum Nürnberg, Nürnberg, Germany.
4
Department of Cardiac Surgery, Universitätsklinikum Münster, Münster, Germany.

Abstract

OBJECTIVE:

This propensity-matched study compared clinical and echocardiographic outcomes between patients undergoing transcatheter aortic valve implantation (TAVI) and sutureless aortic valve replacement.

METHODS:

From January 2010 to March 2012, 122 patients (age 79.4 ± 5.3 years, logistic euroSCORE 12% ± 8.4%) underwent minimally invasive sutureless aortic valve replacement, and 122 (age 84.6 ± 6.2 years, logistic euroSCORE 20.9% ± 2.5%) underwent TAVI. After propensity matching, 37 matched pairs were available for analysis.

RESULTS:

Preoperative characteristics and risk scores of matched groups were comparable. In-hospital mortalities were 0% in the sutureless group and 8.1% (n = 3) in the TAVI group (P = .24). Permanent pacemaker implantation was required in 4 patients in the sutureless group and 1 patient in the TAVI group (10.8% vs 2.7%; P = .18). A neurologic event was recorded in 2 patients of each group. Predischarge echocardiographic data showed higher paravalvular leak rate in the TAVI group (13.5% vs 0%; P = .027). At mean follow-up of 18.9 ± 10.1 months, overall cumulative survival was 91.9% and significantly differed between groups (sutureless 97.3% vs TAVI 86.5%; P = .015). In the TAVI group, a significant difference in mortality was observed between patients with (n = 20) and without (n = 17) paravalvular leak (25% vs 0%; P = .036).

CONCLUSIONS:

Combining the advantage of standard diseased valve removal with shorter procedural times, minimally invasive sutureless aortic valve replacement may be the first-line treatment for high-risk patients considered in the "gray zone" between TAVI and conventional surgery.

KEYWORDS:

28; 28.1; 35; 35.2; AVR; CABG; CORONARY; Coronary Artery Bypass Surgery Off- or On-Pump Revascularization Study; PARTNER; Placement of AoRTic TraNscathetER Valve [trial]; Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve [trial]; TAVI; TRITON; aortic valve replacement; coronary artery bypass grafting; transcatheter aortic valve implantation

PMID:
24280712
DOI:
10.1016/j.jtcvs.2013.10.025
[Indexed for MEDLINE]
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