Mohamed Abdel-Wahab1, Buntaro Fujita2, Christian Frerker3, Timm Bauer4, Andreas Beckmann5, Raffi Bekeredjian6, Sabine Bleiziffer7, Helge Möllmann8, Thomas Walther9, Christian Hamm10, Friedhelm Beyersdorf11, Andreas Zeiher12, Jan Gummert7, Eva Herrmann13, Michael A Borger14, David Holzhey14, Holger Thiele15, Stephan Ensminger2. 1. Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany. Electronic address: mohamed.abdel-wahab@medizin.uni-leipzig.de. 2. Department of Cardiac Surgery, University Hospital Lübeck, Lübeck, Germany. 3. Department of Cardiology, University Hospital Cologne, University of Cologne Faculty of Medicine, Cologne, Germany. 4. Department of Cardiology, Sana Klinikum Offenbach, Offenbach, Germany. 5. German Society for Thoracic and Cardiovascular Surgery, Berlin, Germany. 6. Department of Cardiology, Robert-Bosch-Hospital, Stuttgart, Germany. 7. Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany. 8. Department of Internal Medicine I, St.-Johannes-Hospital, Dortmund, Germany. 9. Department of Thoracic, Cardiac and Thoracic Vascular Surgery, University of Frankfurt, Frankfurt, Germany. 10. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. 11. Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Medical Faculty of the Albert Ludwig University, Freiburg, Germany. 12. Department of Cardiology, Angiology and Nephrology, University of Frankfurt, Frankfurt, Germany. 13. German Center for Cardiovascular Research (DZHK), Partner Site Rhein/Main, Frankfurt, Germany. 14. Leipzig Heart Institute, Leipzig, Germany; Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany. 15. Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany.
Abstract
OBJECTIVES: This study sought to compare patient characteristics, procedural outcomes, and valve hemodynamics of surgical aortic valve replacement (SAVR) with current-generation rapid-deployment valves (RDVs) versus transcatheter aortic valve replacement (TAVR) with current-generation transcatheter heart valves (THVs). BACKGROUND: The patient population currently treated with RDVs may have potential similarities with the current TAVR population, but comparative studies in a large patient population remain scarce. METHODS: A total of 16,473 patients who underwent isolated SAVR using current-generation RDVs or isolated transfemoral TAVR with current-generation THVs between 2011 and 2017 were enrolled into the German Aortic Valve Registry. Baseline, procedural, and in-hospital outcome parameters were analyzed for RDVs and THVs before and after 1:1 propensity score matching. Furthermore, RDVs and THVs with similar design characteristics were compared with each other. RESULTS: A total of 1,743 patients received SAVR with an RDV, whereas 14,730 patients were treated with transfemoral TAVR. Patients treated with TAVR were significantly older and had higher surgical risk scores. Following valve replacement, patients treated with an RDV had a significantly higher rate of disabling stroke (1.7% vs. 1.1%; p = 0.03), need for transfusion of >4 red blood cell units (8.5% vs. 1.4%; p < 0.001), and new onset renal replacement therapy (1.9% vs. 1.2%; p = 0.01), whereas the need for a new permanent pacemaker was lower (8.4% vs. 14.9%; p < 0.001). In-hospital mortality was similar (1.6% vs. 1.8%; p = 0.62). These findings persisted after 1:1 propensity score matching, but in-hospital mortality was significantly higher after RDVs (1.7% vs. 0.6%; p = 0.003). Balloon-expandable (BE) RDVs had significantly lower residual gradients compared with BE-THVs, while self-expanding (SE)-RDVs had significantly higher residual gradients compared with SE-THVs. CONCLUSIONS: In a large all-comers' registry, TAVR with current-generation THVs was associated with improved in-hospital outcomes compared with SAVR with current-generation RDVs. The pacemaker rate is significantly higher with TAVR. Post-procedural hemodynamic function varied between individual RDVs and THVs.
OBJECTIVES: This study sought to compare patient characteristics, procedural outcomes, and valve hemodynamics of surgical aortic valve replacement (SAVR) with current-generation rapid-deployment valves (RDVs) versus transcatheter aortic valve replacement (TAVR) with current-generation transcatheter heart valves (THVs). BACKGROUND: The patient population currently treated with RDVs may have potential similarities with the current TAVR population, but comparative studies in a large patient population remain scarce. METHODS: A total of 16,473 patients who underwent isolated SAVR using current-generation RDVs or isolated transfemoral TAVR with current-generation THVs between 2011 and 2017 were enrolled into the German Aortic Valve Registry. Baseline, procedural, and in-hospital outcome parameters were analyzed for RDVs and THVs before and after 1:1 propensity score matching. Furthermore, RDVs and THVs with similar design characteristics were compared with each other. RESULTS: A total of 1,743 patients received SAVR with an RDV, whereas 14,730 patients were treated with transfemoral TAVR. Patients treated with TAVR were significantly older and had higher surgical risk scores. Following valve replacement, patients treated with an RDV had a significantly higher rate of disabling stroke (1.7% vs. 1.1%; p = 0.03), need for transfusion of >4 red blood cell units (8.5% vs. 1.4%; p < 0.001), and new onset renal replacement therapy (1.9% vs. 1.2%; p = 0.01), whereas the need for a new permanent pacemaker was lower (8.4% vs. 14.9%; p < 0.001). In-hospital mortality was similar (1.6% vs. 1.8%; p = 0.62). These findings persisted after 1:1 propensity score matching, but in-hospital mortality was significantly higher after RDVs (1.7% vs. 0.6%; p = 0.003). Balloon-expandable (BE) RDVs had significantly lower residual gradients compared with BE-THVs, while self-expanding (SE)-RDVs had significantly higher residual gradients compared with SE-THVs. CONCLUSIONS: In a large all-comers' registry, TAVR with current-generation THVs was associated with improved in-hospital outcomes compared with SAVR with current-generation RDVs. The pacemaker rate is significantly higher with TAVR. Post-procedural hemodynamic function varied between individual RDVs and THVs.
Authors: Christian Frerker; Tobias Schmidt; Max M Meertens; Sascha Macherey; Sebastiaan Asselberghs; Samuel Lee; Jan Hendrik Schipper; Barend Mees; Ingo Eitel; Stephan Baldus Journal: Clin Res Cardiol Date: 2022-03-17 Impact factor: 6.138
Authors: Tsuyoshi Kaneko; Sreekanth Vemulapalli; Shun Kohsaka; Kazuo Shimamura; Amanda Stebbins; Hiraku Kumamaru; Adam J Nelson; Andrzej Kosinski; Koichi Maeda; Joseph E Bavaria; Shigeru Saito; Michael J Reardon; Toru Kuratani; Jeffrey J Popma; Taku Inohara; Vinod H Thourani; John D Carroll; Hideyuki Shimizu; Morimasa Takayama; Martin B Leon; Michael J Mack; Yoshiki Sawa Journal: J Am Heart Assoc Date: 2022-03-04 Impact factor: 6.106