Augusto D'Onofrio1, Stefano Salizzoni2, Antonino S Rubino3, Laura Besola4, Claudia Filippini2, Ottavio Alfieri5, Antonio Colombo5, Marco Agrifoglio6, Theodor Fischlein7, Filippo Rapetto8, Giuseppe Tarantini4, Magnus Dalèn9, Davide Gabbieri10, Bart Meuris11, Carlo Savini12, Giuseppe Gatti13, Marco Luigi Aiello14, Fausto Biancari15, Ugolino Livi16, Pier Luigi Stefàno17, Mauro Cassese18, Bruno Borrello19, Mauro Rinaldi3, Carmelo Mignosa2, Gino Gerosa4. 1. Division of Cardiac Surgery, University of Padova, Padova, Italy. Electronic address: adonofrio@hotmail.it. 2. Department of Cardiac Surgery, University of Turin-Città della Salute e della Sceinza-Molinette, Turin, Italy. 3. Department of Cardiac Surgery, AOU-Policlinico Vittorio Emanuele, University of Catania, Catania, Italy. 4. Division of Cardiac Surgery, University of Padova, Padova, Italy. 5. Department of Cardiac Surgery, San Raffaele Hospital, Milan, Italy. 6. Department of Cardiac Surgery, University of Milan-Monzino Hospital, Milan, Italy. 7. Department of Cardiac Surgery, Nürnberg Clinic, Nürnberg, Germany. 8. Department of Cardiac Surgery, IRCCS San Martino-National Institute for Cancer Research, Genova, Italy. 9. Department of Cardiac Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden. 10. Department of Cardiac Surgery, Hesperia Hospital, Modena, Italy. 11. Department of Cardiac Surgery, University Hospital Gasthuisberg, Leuven, Belgium. 12. Department of Cardiac Surgery, Azienda Ospedaliera Universitaria S. Orsola, Bologna, Italy. 13. Department of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. 14. Department of Cardiac Surgery, IRCCS Policlinico S. Matteo, Pavia, Italy. 15. Department of Cardiac Surgery, Oulu University Hospital, Oulu, Finland. 16. Department of Cardiac Surgery, AOU S. Maria Misericordia, Udine, Italy. 17. Department of Cardiac Surgery, AOU Careggi, Firenze, Italy. 18. Department of Cardiac Surgery, S. Maria Hospital, Bari, Italy. 19. Ospedale Maggiore, Parma, Italy.
Abstract
OBJECTIVE: Transcatheter aortic valve implantation (TAVI) and sutureless aortic valve replacement (SU-AVR) are suitable alternatives to conventional surgery. The aim of this study is to compare early outcomes of patients undergoing TAVI and SU-AVR. METHODS: Data were analyzed on patients who underwent TAVI and patients who underwent SU-AVR. Two matched cohorts (TAVI vs SU-AVR) were created using propensity scores; all analyses were repeated for transapical TAVI and transfemoral TAVI, separately. Outcomes were defined according to Valve Academic Research Consortium-2 criteria. RESULTS: A total of 2177 patients were included in the analysis: 1885 (86.6%) treated with TAVI; 292 (13.4%) treated with SU-AVR. Mortality in unmatched TAVI and SU-AVR patients was 7.1% and 2.1%, respectively, at 30 days, and 12.9% and 4.6%, respectively, at 1 year. No differences were found in 30-day mortality in the 214 matched patient pairs (3.7% vs 2.3%; P = .4), but patients treated with TAVI showed a lower incidence of device success (85.9% vs 98.6%; P < .001) and pacemaker implantation (2.8% vs 9.4%; P = .005), and a higher incidence of any paravalvular leakage (PVL). CONCLUSIONS: SU-AVR is associated with better device success and a lower incidence of PVL, compared with TAVI. Nevertheless, patients treated with SU-AVR were more likely to receive a permanent pacemaker. SU-AVR and TAVI provide good results in patients who have severe symptomatic aortic valve stenosis. Given the multiple therapeutic options available, patients may receive the treatment that is most appropriate for their clinical and anatomical characteristics.
OBJECTIVE: Transcatheter aortic valve implantation (TAVI) and sutureless aortic valve replacement (SU-AVR) are suitable alternatives to conventional surgery. The aim of this study is to compare early outcomes of patients undergoing TAVI and SU-AVR. METHODS: Data were analyzed on patients who underwent TAVI and patients who underwent SU-AVR. Two matched cohorts (TAVI vs SU-AVR) were created using propensity scores; all analyses were repeated for transapical TAVI and transfemoral TAVI, separately. Outcomes were defined according to Valve Academic Research Consortium-2 criteria. RESULTS: A total of 2177 patients were included in the analysis: 1885 (86.6%) treated with TAVI; 292 (13.4%) treated with SU-AVR. Mortality in unmatched TAVI and SU-AVR patients was 7.1% and 2.1%, respectively, at 30 days, and 12.9% and 4.6%, respectively, at 1 year. No differences were found in 30-day mortality in the 214 matched patient pairs (3.7% vs 2.3%; P = .4), but patients treated with TAVI showed a lower incidence of device success (85.9% vs 98.6%; P < .001) and pacemaker implantation (2.8% vs 9.4%; P = .005), and a higher incidence of any paravalvular leakage (PVL). CONCLUSIONS: SU-AVR is associated with better device success and a lower incidence of PVL, compared with TAVI. Nevertheless, patients treated with SU-AVR were more likely to receive a permanent pacemaker. SU-AVR and TAVI provide good results in patients who have severe symptomatic aortic valve stenosis. Given the multiple therapeutic options available, patients may receive the treatment that is most appropriate for their clinical and anatomical characteristics.
Authors: Declan Lloyd; Jessica G Y Luc; Ben Elias Indja; Vannessa Leung; Nelson Wang; Kevin Phan Journal: J Thorac Dis Date: 2019-01 Impact factor: 2.895