Peter E Umukoro1,2, Paul Yeung-Lai-Wah2, Sunil Pathak2, Sabri Elkhidir2, Deepa Soodi2, Brooke Delgoffe3, Richard Berg3, Kelley P Anderson4, Romel J Garcia-Montilla5. 1. Current affiliation: Physician, Indiana University School of Medicine, Indianapolis, IN, USA Institution where this work was completed: Marshfield Medical Center, Marshfield, Wisconsin. peu258@mail.harvard.edu. 2. Department of Internal Medicine, Marshfield Clinic Health System, Marshfield, WI USA. 3. Office of Research Computing and Analytics, Marshfield Clinic Research Institute, Marshfield, WI USA. 4. Department of Cardiology, Marshfield Clinic Health System, Marshfield, WI USA. 5. Department of Surgical Intensive Care Unit, Marshfield Medical Center, Marshfield, WI USA.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a rapidly evolving treatment for severe aortic stenosis. However, uncertainties exist for optimal valve selection as there are few long-term studies comparing patient survival by valve type.Objective: We hypothesized that self-expandable valves (SEV) would provide a survival advantage over balloon expandable valves (BEV), as SEV continue to expand and might better accommodate to the anatomy of the aortic valve over time. Methods: We examined outcomes according to valve type from a rural tertiary referral center between 2012 and 2017. Results: Out of 269 patients, 77 deaths (28.6%) occurred over the study period with 6 deaths by 1 month post-TAVR and 37 deaths by 1 year post-TAVR. The median observation time for survivors was 21.5 months. The probability of survival at 3 years was 60.7% and 61.9% for patients who underwent treatment with SEV and BEV, respectively. There was no statistically significant difference in overall patient survival with or without adjustment for factors such as age, sex, race, and aortic valve area. Additionally, in a secondary analysis restricted to those patients treated in later years (2015-2017) survival among patients with BEV appeared superior (HR=0.456, P=0.015). Conclusion: Patients who underwent TAVR at a rural medical center with SEV showed similar survival compared to those who received a BEV. Superior survival was observed among those who received BEV versus SEV between 2015 and 2017.
Background: Transcatheter aortic valve replacement (TAVR) is a rapidly evolving treatment for severe aortic stenosis. However, uncertainties exist for optimal valve selection as there are few long-term studies comparing patient survival by valve type.Objective: We hypothesized that self-expandable valves (SEV) would provide a survival advantage over balloon expandable valves (BEV), as SEV continue to expand and might better accommodate to the anatomy of the aortic valve over time. Methods: We examined outcomes according to valve type from a rural tertiary referral center between 2012 and 2017. Results: Out of 269 patients, 77 deaths (28.6%) occurred over the study period with 6 deaths by 1 month post-TAVR and 37 deaths by 1 year post-TAVR. The median observation time for survivors was 21.5 months. The probability of survival at 3 years was 60.7% and 61.9% for patients who underwent treatment with SEV and BEV, respectively. There was no statistically significant difference in overall patient survival with or without adjustment for factors such as age, sex, race, and aortic valve area. Additionally, in a secondary analysis restricted to those patients treated in later years (2015-2017) survival among patients with BEV appeared superior (HR=0.456, P=0.015). Conclusion:Patients who underwent TAVR at a rural medical center with SEV showed similar survival compared to those who received a BEV. Superior survival was observed among those who received BEV versus SEV between 2015 and 2017.
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