Arie Finkelstein1, Arie Lorin Schwartz1, Gideon Uretzky2, Shmuel Banai1, Gad Keren1, Amir Kramer2, Yan Topilsky3. 1. Division of Cardiovascular Diseases, Tel Aviv Medical Center, Tel-Aviv, Israel. 2. Division of Cardiovascular Surgery, Tel Aviv Medical Center, Tel-Aviv, Israel. 3. Division of Cardiovascular Diseases, Tel Aviv Medical Center, Tel-Aviv, Israel. Electronic address: topilskyyan@gmail.com.
Abstract
OBJECTIVES: We aimed to compare the performance and midterm survival of transcutaneous aortic valve replacement (TAVR) and surgically implanted stentless aortic valve replacement (SAVR) for severe aortic stenosis in patients anticipated to have patient-prosthesis mismatch (PPM). METHODS: A retrospective analysis was performed of 86 and 49 consecutive TAVR and SAVR patients with severe aortic stenosis and calculated minimal effective orifice area larger than the best projected effective orifice area. Cox hazard analyses were used to assess the effect of TAVR versus SAVR on outcome. RESULTS: The peak and mean transprosthetic gradient at discharge were lower (P < .001 for both) in the TAVR group. Mild or greater aortic regurgitation was more frequent in the TAVR group (61% vs 7%; P < .0001). At 3 months of follow-up, the mean gradient in the TAVR group was similar to that of the SAVR group but the prevalence of aortic regurgitation was still higher. The unadjusted 3-year survival rate was superior in the SAVR versus TAVR group (91.6% ± 4% vs 67.0% ± 7%; P = .01). Adjustments for both age and comorbidity resulted in loss of the difference in mortality between the 2 groups. CONCLUSIONS: In patients with anticipated PPM, TAVR offers an immediate lower incidence of PPM than SAVR but a greater prevalence of aortic regurgitation. The differences in transaortic gradients became nonsignificant 3 months postoperatively. The question of whether TAVR is a suitable substitute for SAVR in patients with anticipated PPM, in particular, those who are older and sicker, warrants additional investigation.
OBJECTIVES: We aimed to compare the performance and midterm survival of transcutaneous aortic valve replacement (TAVR) and surgically implanted stentless aortic valve replacement (SAVR) for severe aortic stenosis in patients anticipated to have patient-prosthesis mismatch (PPM). METHODS: A retrospective analysis was performed of 86 and 49 consecutive TAVR and SAVR patients with severe aortic stenosis and calculated minimal effective orifice area larger than the best projected effective orifice area. Cox hazard analyses were used to assess the effect of TAVR versus SAVR on outcome. RESULTS: The peak and mean transprosthetic gradient at discharge were lower (P < .001 for both) in the TAVR group. Mild or greater aortic regurgitation was more frequent in the TAVR group (61% vs 7%; P < .0001). At 3 months of follow-up, the mean gradient in the TAVR group was similar to that of the SAVR group but the prevalence of aortic regurgitation was still higher. The unadjusted 3-year survival rate was superior in the SAVR versus TAVR group (91.6% ± 4% vs 67.0% ± 7%; P = .01). Adjustments for both age and comorbidity resulted in loss of the difference in mortality between the 2 groups. CONCLUSIONS: In patients with anticipated PPM, TAVR offers an immediate lower incidence of PPM than SAVR but a greater prevalence of aortic regurgitation. The differences in transaortic gradients became nonsignificant 3 months postoperatively. The question of whether TAVR is a suitable substitute for SAVR in patients with anticipated PPM, in particular, those who are older and sicker, warrants additional investigation.
Authors: Karol Zbroński; Bartosz Rymuza; Piotr Scisło; Kajetan Grodecki; Paulina Dobkowska; Marek Wawrzacz; Radosław Wilimski; Anna Słowikowska; Janusz Kochman; Krzysztof J Filipiak; Grzegorz Opolski; Zenon Huczek Journal: Postepy Kardiol Interwencyjnej Date: 2017-11-29 Impact factor: 1.426