Francesco Onorati1, Paola D'Errigo2, Claudio Grossi3, Marco Barbanti4, Marco Ranucci5, Daniel Remo Covello6, Stefano Rosato2, Alice Maraschini2, Gennaro Santoro7, Corrado Tamburino4, Fulvia Seccareccia2, Francesco Santini8, Lorenzo Menicanti5. 1. Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy. Electronic address: frankono@libero.it. 2. National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy. 3. Department of Cardiovascular Surgery, S. Croce e Carle Hospital, Cuneo, Italy. 4. Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy, and Excellence Through Newest Advances Foundation, Catania, Italy. 5. Department of Cardiothoracic and Vascular Anesthesia-Intensive Care Unit and Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. 6. Department of Anesthesia and Intensive Care, IRCCS San Raffaele, Milan, Italy. 7. Division of Cardiology, Careggi Hospital, Florence, Italy. 8. Division of Cardiac Surgery, University Hospital San Martino, Genoa, Italy.
Abstract
OBJECTIVE: Despite demonstration of the superior outcomes of transcatheter aortic valve implantation (TAVI) versus optimal medical therapy for severe left ventricular systolic dysfunction, studies comparing TAVI and surgical aortic valve replacement (AVR) in this high-risk group have been lacking. METHODS: We performed propensity matching for age, gender, baseline comorbidities, previous interventions, priority at hospital admission, frailty score, New York Heart Association class, EuroSCORE, and associated cardiac diseases. Next, the 30-day mortality and procedure-related morbidity of 162 patients (81 TAVI vs 81 AVR) with severe left ventricular systolic dysfunction (ejection fraction ≤ 35%) were analyzed at the Italian National Institute of Health. RESULTS: The 30-day mortality was comparable (P = .37) between the 2 groups. The incidence of periprocedural acute myocardial infarction (P = .55), low output state (P = .27), stroke (P = .36), and renal dysfunction (peak creatinine level, P = .57) was also similar between the 2 groups. TAVI resulted in significantly greater postprocedural permanent pacemaker implantation (P = .01) and AVR in more periprocedural transfusions (P < .01) despite a similar transfusion rate per patient (2.8 ± 3.7 for TAVI vs 4.4 ± 3.8 for AVR; P = .08). The postprocedural intensive care unit stay (median, 2 days after TAVI vs 3 days after AVR; P = .34), intermediate care unit stay (median, 0 days after both TAVI and AVR; P = .94), and hospitalization (median, 11 days after TAVI vs 14 days after AVR; P = .51) were comparable. CONCLUSIONS: In patients with severe left ventricular systolic dysfunction, both TAVI and AVR are valid treatment options, with comparable hospital mortality and periprocedural morbidity. Comparisons of the mid- to long-term outcomes are mandatory.
OBJECTIVE: Despite demonstration of the superior outcomes of transcatheter aortic valve implantation (TAVI) versus optimal medical therapy for severe left ventricular systolic dysfunction, studies comparing TAVI and surgical aortic valve replacement (AVR) in this high-risk group have been lacking. METHODS: We performed propensity matching for age, gender, baseline comorbidities, previous interventions, priority at hospital admission, frailty score, New York Heart Association class, EuroSCORE, and associated cardiac diseases. Next, the 30-day mortality and procedure-related morbidity of 162 patients (81 TAVI vs 81 AVR) with severe left ventricular systolic dysfunction (ejection fraction ≤ 35%) were analyzed at the Italian National Institute of Health. RESULTS: The 30-day mortality was comparable (P = .37) between the 2 groups. The incidence of periprocedural acute myocardial infarction (P = .55), low output state (P = .27), stroke (P = .36), and renal dysfunction (peak creatinine level, P = .57) was also similar between the 2 groups. TAVI resulted in significantly greater postprocedural permanent pacemaker implantation (P = .01) and AVR in more periprocedural transfusions (P < .01) despite a similar transfusion rate per patient (2.8 ± 3.7 for TAVI vs 4.4 ± 3.8 for AVR; P = .08). The postprocedural intensive care unit stay (median, 2 days after TAVI vs 3 days after AVR; P = .34), intermediate care unit stay (median, 0 days after both TAVI and AVR; P = .94), and hospitalization (median, 11 days after TAVI vs 14 days after AVR; P = .51) were comparable. CONCLUSIONS: In patients with severe left ventricular systolic dysfunction, both TAVI and AVR are valid treatment options, with comparable hospital mortality and periprocedural morbidity. Comparisons of the mid- to long-term outcomes are mandatory.
Authors: Charat Thongprayoon; Wisit Cheungpasitporn; Narat Srivali; Andrew M Harrison; Tina M Gunderson; Wonngarm Kittanamongkolchai; Kevin L Greason; Kianoush B Kashani Journal: J Am Soc Nephrol Date: 2015-10-20 Impact factor: 10.121
Authors: Yasar Sattar; David Song; Talal Almas; Mohamed Zghouzi; Usama Talib; Abdul-Rahman M Suleiman; Bachar Ahmad; Junaid Arshad; Waqas Ullah; Muhammad Zia Khan; Christopher M Bianco; Rodrigo Bagur; Muhammad Rashid; Mamas A Mamas; M Chadi Alraies Journal: Int J Cardiol Heart Vasc Date: 2022-09-15