Format

Send to

Choose Destination
See comment in PubMed Commons below
Catheter Cardiovasc Interv. 2015 Oct;86(4):738-44. doi: 10.1002/ccd.25866. Epub 2015 Mar 17.

A comparison of transcatheter aortic valve implantation and surgical aortic valve replacement in 1,141 patients with severe symptomatic aortic stenosis and less than high risk.

Author information

1
1Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Freiburg, Germany.
2
Clinic for Cardiac Surgery, Karlsruhe, Germany.
3
Institut Für Pharmakologie und Präventive Medizin, Mahlow, Germany.
4
Medical Clinic III-Department of Cardiology, Vincentius Hospital, Karlsruhe, Germany.
5
Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
6
Munich Graduate School of Economics LMU, Munich, Germany.
7
Medical Clinic I-Department of Cardiology, Mannheim University, Mannheim, Germany.

Abstract

OBJECTIVES:

To assess outcomes for patients undergoing transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement but with less than high risk.

BACKGROUND:

While there is abundant data for high risk patients there is insufficient data for reduced risk.

METHODS:

Patients undergoing TAVI or SAVR between 2007 and 2012 in Karlsruhe were considered. They were assessed by cardiac computed tomography, transoesophageal echocardiogram, and logistic EuroSCORE I (ES) and groups compared using Propensity Score Matching.

RESULTS:

The mean ES was 10.1±2.8 in the TAVI group (n = 419) and 5.7 ± 3.2 in the SAVR group (n = 722; P < 0.0001). Mean survival probability over 3 years was higher in patients undergoing surgery (P < 0.0001). A total of 432 patients were considered for the matched-pairs analysis based on propensity scores (216 in each group). Major vascular complications (10.6% vs. 0.0%; P < 0.0001), new pacemaker implantation (13.9% vs. 4.6%; P < 0.001) and moderate aortic insufficiency (3.2% vs. 0.5%; P = 0.03) were more frequent in patients undergoing TAVI. Major (20.8% vs. 4.2%; P < 0.0001) and life-threatening (14.5% vs. 2.3%; P < 0.0001) bleeding complications were more frequent in those undergoing surgery. Survival probability over 3 years in the propensity matched cohort was comparable between both groups (P = 0.16).

CONCLUSIONS:

In this large, single center, real world dataset there was no difference in mortality between patients undergoing TAVI or SAVR during a 3-year follow-up but there was a TAVI related increase in major vascular complications, new pacemaker implantation and aortic insufficiency and a SAVR related increased bleeding risk.

KEYWORDS:

EuroSCORE; TAVI; age; mortality; risk factors; surgery

PMID:
25641398
DOI:
10.1002/ccd.25866
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments

    Supplemental Content

    Full text links

    Icon for Wiley
    Loading ...
    Support Center