Nelson Wang1, Yi-Chin Tsai2, Natasha Niles2, Vakhtang Tchantchaleishvili3, Marco Di Eusanio4, Tristan D Yan2, Kevin Phan5. 1. Department of Medicine, University of Sydney, Sydney, Australia. 2. The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia. 3. Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, MN, USA. 4. Cardiac Surgery Unit, Cardiovascular Department, 'G. Mazzini' Hospital Piazza Italia, Teramo, Italy. 5. Department of Medicine, University of Sydney, Sydney, Australia;; The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
Abstract
BACKGROUND: With improving technologies and an increasingly elderly populations, there have been an increasing number of therapeutic options available for patients requiring aortic valve replacement. Recent evidence suggests that transcatheter aortic valve implantation (TAVI) is one suitable option for high risk inoperable patients, as well as high risk operable patients. Sutureless valve technology has also been developed concurrently, with facilitates surgical aortic valve replacement (SUAVR) by allow resection and replacement of the native aortic valve with minimal sutures and prosthesis anchoring required. For patients amenable for both TAVI and SUAVR, the evidence is unclear with regards to the benefits and risks of either approach. The objectives are to compare the perioperative outcomes and intermediate-term survival rates of TAVI and SUAVR in matched or propensity score matched studies. METHODS: A systematic literature search was performed to include all matched or propensity score matched studies comparing SUAVR versus TAVI for severe aortic stenosis. A meta-analysis with odds ratios (OR) and mean differences were performed to compare key outcomes including paravalvular regurgitation and short and intermediate term mortality. RESULTS: Six studies met our inclusion criteria giving a total of 741 patients in both the SUAVR and TAVI arm of the study. Compared to TAVI, SUAVR had a lower incidence of paravalvular leak (OR =0.06; 95% CI: 0.03-0.12, P<0.01). There was no difference in perioperative mortality, however SUAVR patients had significantly better survival rates at 1 (OR =2.40; 95% CI: 1.40-4.11, P<0.01) and 2 years (OR =4.62; 95% CI: 2.62-8.12, P<0.01). CONCLUSIONS: The present study supports the use of minimally invasive SUAVR as an alternative to TAVI in high risk patients requiring aortic replacement. The presented results require further validation in prospective, randomized controlled studies.
BACKGROUND: With improving technologies and an increasingly elderly populations, there have been an increasing number of therapeutic options available for patients requiring aortic valve replacement. Recent evidence suggests that transcatheter aortic valve implantation (TAVI) is one suitable option for high risk inoperable patients, as well as high risk operable patients. Sutureless valve technology has also been developed concurrently, with facilitates surgical aortic valve replacement (SUAVR) by allow resection and replacement of the native aortic valve with minimal sutures and prosthesis anchoring required. For patients amenable for both TAVI and SUAVR, the evidence is unclear with regards to the benefits and risks of either approach. The objectives are to compare the perioperative outcomes and intermediate-term survival rates of TAVI and SUAVR in matched or propensity score matched studies. METHODS: A systematic literature search was performed to include all matched or propensity score matched studies comparing SUAVR versus TAVI for severe aortic stenosis. A meta-analysis with odds ratios (OR) and mean differences were performed to compare key outcomes including paravalvular regurgitation and short and intermediate term mortality. RESULTS: Six studies met our inclusion criteria giving a total of 741 patients in both the SUAVR and TAVI arm of the study. Compared to TAVI, SUAVR had a lower incidence of paravalvular leak (OR =0.06; 95% CI: 0.03-0.12, P<0.01). There was no difference in perioperative mortality, however SUAVRpatients had significantly better survival rates at 1 (OR =2.40; 95% CI: 1.40-4.11, P<0.01) and 2 years (OR =4.62; 95% CI: 2.62-8.12, P<0.01). CONCLUSIONS: The present study supports the use of minimally invasive SUAVR as an alternative to TAVI in high risk patients requiring aortic replacement. The presented results require further validation in prospective, randomized controlled studies.
Authors: David S Bach; Derrick Siao; Steven E Girard; Claire Duvernoy; Benjamin D McCallister; Sarah K Gualano Journal: Circ Cardiovasc Qual Outcomes Date: 2009-10-27
Authors: Luis Nombela-Franco; Josep Rodés-Cabau; Robert DeLarochellière; Eric Larose; Daniel Doyle; Jacques Villeneuve; Sébastien Bergeron; Mathieu Bernier; Ignacio J Amat-Santos; Michael Mok; Marina Urena; Michel Rheault; Jean Dumesnil; Mélanie Côté; Philippe Pibarot; Eric Dumont Journal: JACC Cardiovasc Interv Date: 2012-05 Impact factor: 11.195
Authors: F Schwarz; P Baumann; J Manthey; M Hoffmann; G Schuler; H C Mehmel; W Schmitz; W Kübler Journal: Circulation Date: 1982-11 Impact factor: 29.690
Authors: Augusto D'Onofrio; Stefano Salizzoni; Antonino S Rubino; Laura Besola; Claudia Filippini; Ottavio Alfieri; Antonio Colombo; Marco Agrifoglio; Theodor Fischlein; Filippo Rapetto; Giuseppe Tarantini; Magnus Dalèn; Davide Gabbieri; Bart Meuris; Carlo Savini; Giuseppe Gatti; Marco Luigi Aiello; Fausto Biancari; Ugolino Livi; Pier Luigi Stefàno; Mauro Cassese; Bruno Borrello; Mauro Rinaldi; Carmelo Mignosa; Gino Gerosa Journal: J Thorac Cardiovasc Surg Date: 2016-01-11 Impact factor: 5.209
Authors: Marco Barbanti; Tae-Hyun Yang; Josep Rodès Cabau; Corrado Tamburino; David A Wood; Hasan Jilaihawi; Phillip Blanke; Raj R Makkar; Azeem Latib; Antonio Colombo; Giuseppe Tarantini; Rekha Raju; Ronald K Binder; Giang Nguyen; Melanie Freeman; Henrique B Ribeiro; Samir Kapadia; James Min; Gudrun Feuchtner; Ronen Gurtvich; Faisal Alqoofi; Marc Pelletier; Gian Paolo Ussia; Massimo Napodano; Fabio Sandoli de Brito; Susheel Kodali; Bjarne L Norgaard; Nicolaj C Hansson; Gregor Pache; Sergio J Canovas; Hongbin Zhang; Martin B Leon; John G Webb; Jonathon Leipsic Journal: Circulation Date: 2013-06-07 Impact factor: 29.690
Authors: Willem Flameng; Marie-Christine Herregods; Hadewich Hermans; Gerry Van der Mieren; Monique Vercalsteren; Gert Poortmans; Jan Van Hemelrijck; Bart Meuris Journal: J Thorac Cardiovasc Surg Date: 2011-04-07 Impact factor: 5.209
Authors: Sammy Elmariah; Igor F Palacios; Thomas McAndrew; Irene Hueter; Ignacio Inglessis; Joshua N Baker; Susheel Kodali; Martin B Leon; Lars Svensson; Philippe Pibarot; Pamela S Douglas; William F Fearon; Ajay J Kirtane; Hersh S Maniar; Jonathan J Passeri Journal: Circ Cardiovasc Interv Date: 2013-11-12 Impact factor: 6.546
Authors: Miguel González Barbeito; Francisco Estévez-Cid; Patricia Pardo Martínez; Carlos Velasco García de Sierra; Carmen Iglesias Gil; Cristina Quiñones Laguillo; José Joaquín Cuenca Castillo Journal: J Thorac Dis Date: 2019-07 Impact factor: 2.895
Authors: Mathew P Doyle; Kei Woldendorp; Martin Ng; Michael P Vallely; Michael K Wilson; Tristan D Yan; Paul G Bannon Journal: J Thorac Dis Date: 2021-03 Impact factor: 3.005