Markus Mach1,2, Thomas Poschner1, Waseem Hasan3, Tillmann Kerbel1, Philipp Szalkiewicz1, Ena Hasimbegovic1,4, Martin Andreas1, Christoph Gross1,5, Andreas Strouhal6, Georg Delle-Karth6, Martin Grabenwöger2,7, Christopher Adlbrecht6,8, Andreas Schober6. 1. Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria. 2. Department of Cardio-Vascular Surgery, Hospital Floridsdorf and Karl Landsteiner Institute for Cardio-Vascular Research, 1210 Vienna, Austria. 3. Faculty of Medicine, Imperial College London, London SW7 2AZ, UK. 4. Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria. 5. Center of Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria. 6. Department of Cardiology, Hospital Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research Vienna, 1210 Vienna, Austria. 7. Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria. 8. Imed19, Private Research Center, 1190 Vienna, Austria.
Abstract
BACKGROUND: Younger patients with severe symptomatic aortic stenosis are a particularly challenging collective with regard to the choice of intervention. High-risk patients younger than 75 years of age are often eligible for both the transcatheter aortic valve replacement (TAVR) and the isolated surgical aortic valve replacement (iSAVR). Data on the outcomes of both interventions in this set of patients are scarce. METHODS: One hundred and forty-four propensity score-matched patients aged 75 years or less who underwent TAVR or iSAVR at the Hietzing Heart Center in Vienna, Austria, were included in the study. The mean age was 68.9 years (TAVR 68.7 vs. SAVR 67.6 years; p = 0.190) and the average EuroSCORE II was 5.4% (TAVR 4.3 [3.2%] vs. iSAVR 6.4 (4.3%); p = 0.194). RESULTS: Postprocedural adverse event data showed higher rates of newly acquired atrial fibrillation (6.9% vs. 19.4%; p = 0.049), prolonged ventilation (2.8% vs. 25.0%; p < 0.001) and multi-organ failure (0% vs. 6.9%) in the surgical cohort. The in-hospital and 30-day mortality was significantly higher for iSAVR (1.4% vs. 13.9%; p = 0.012; 12.5% vs. 2.8%; p = 0.009, respectively). The long-term survival (median follow-up 5.0 years (2.2-14.1 years)) of patients treated with the surgical approach was superior to that of patients undergoing TAVR (p < 0.001). CONCLUSION: Although the survival analysis revealed a higher in-hospital and 30-day survival rate for high-risk patients aged ≤75 years who underwent TAVR, iSAVR was associated with a significantly higher long-term survival rate.
BACKGROUND: Younger patients with severe symptomatic aortic stenosis are a particularly challenging collective with regard to the choice of intervention. High-risk patients younger than 75 years of age are often eligible for both the transcatheter aortic valve replacement (TAVR) and the isolated surgical aortic valve replacement (iSAVR). Data on the outcomes of both interventions in this set of patients are scarce. METHODS: One hundred and forty-four propensity score-matched patients aged 75 years or less who underwent TAVR or iSAVR at the Hietzing Heart Center in Vienna, Austria, were included in the study. The mean age was 68.9 years (TAVR 68.7 vs. SAVR 67.6 years; p = 0.190) and the average EuroSCORE II was 5.4% (TAVR 4.3 [3.2%] vs. iSAVR 6.4 (4.3%); p = 0.194). RESULTS: Postprocedural adverse event data showed higher rates of newly acquired atrial fibrillation (6.9% vs. 19.4%; p = 0.049), prolonged ventilation (2.8% vs. 25.0%; p < 0.001) and multi-organ failure (0% vs. 6.9%) in the surgical cohort. The in-hospital and 30-day mortality was significantly higher for iSAVR (1.4% vs. 13.9%; p = 0.012; 12.5% vs. 2.8%; p = 0.009, respectively). The long-term survival (median follow-up 5.0 years (2.2-14.1 years)) of patients treated with the surgical approach was superior to that of patients undergoing TAVR (p < 0.001). CONCLUSION: Although the survival analysis revealed a higher in-hospital and 30-day survival rate for high-risk patients aged ≤75 years who underwent TAVR, iSAVR was associated with a significantly higher long-term survival rate.
Entities:
Keywords:
SAVR; TAVI; TAVR; aortic stenosis; young
Authors: Johnny Chahine; Zeina Jedeon; Jacob Fiocchi; Andrew Shaffer; Ryan Knoper; Ranjit John; Demetris Yannopoulos; Ganesh Raveendran; Sergey Gurevich Journal: Health Sci Rep Date: 2022-05-22