Clinical outcomes in patients after surgical and transcatheter aortic valve replacement

Abstract

INTRODUCTION Transcatheter aortic valve implantation (TAVI) and minimally invasive aortic valve replacement (minithoracotomy and ministernotomy) have become a valuable alternative to conventional surgical treatment of severe aortic stenosis (AS) in high-risk patients. OBJECTIVESThe aim of the study was to evaluate long-term results and complications in patients with symptomatic AS treated with TAVI, surgical aortic valve replacement (SAVR), minithoracotomy, or ministernotomy. PATIENTS AND METHODSA total of 173 patients with symptomatic AS were enrolled to the study between the years 2011 and 2013. Propensity scores were calculated for TAVI and each surgical method separately. Differences in clinical outcomes between patients treated with TAVI and those treated with surgical methods were adjusted for propensity scores using a logistic regression analysis and presented as adjusted odds ratios with 95% confidence intrervals.RESULTS A median follow-up was 583.5 days (interquartile range, 298-736 days). Before aortic valve replacement (AVR), no significant differences in ejection fraction (EF) were observed between the groups. At 1 week after AVR, mean EF values were significantly higher in patients after TAVI in comparison with the other groups (TAVI, 50.2% ±13.1%; minithoracotomy, 44.1% ±13.4%; ministernotomy, 37.8% ±12.8%; SAVR, 40.3% ±12.5%; P = 0.001). There were no differences in the longest available follow-up mortality between the analyzed groups (P = 0.8). To our best knowledge, this is the first study comparing minithoracotomy, ministernotomy, and SAVR with TAVI in terms of long-term outcomes such as the longest available follow-up mortality, left ventricular (LV) function, complications after the procedure, and conduction disturbances and arrhythmias after the procedure.CONCULSIONS Patients undergoing TAVI show more beneficial long-term outcomes in comparison with patients undergoing minithoracotomy, ministernotomy, and SAVR and do not differ in terms of the longest available follow-up mortality. TAVI seems to have a more favorable effect on LV function and an increase in EF in comparison with the surgical methods.

Assessment of quality of life in patients after surgical and transcatheter aortic valve replacement

“…Complete clinical results and follow‐up data were reported previously . Briefly, TAVI group consisted of 39 patients (22.5%), mini‐sternotomy was performed in 44 patients (25.5%), mini‐thoracotomy in 50 (29%), and AVR in 40 patients (23%).…”

Association Between Blood Transfusions and 12-Month Mortality After Transcatheter Aortic Valve Implantation

“…12) Previous data showed that there were no significant differences between TAVI patients and patients undergoing AVR via minithoracotomy, ministernotomy, and surgical AVR in terms of blood transfusions during hospitalization, however, access site complications were frequent. 30) Limitations: Our findings are presented with several limitations including a small sample size and recruitment from only one center. The overall number of deaths at 12 months was low (18 events) and thus the results from multivariate Cox regression analysis should be considered to be rather exploratory and hypothesis-generating.…”

The obesity paradox in patients undergoing transcatheter aortic valve implantation: is there any effect of body mass index on survival?

“…Despite their detrimental effects on general health status, overweight and obesity were linked with a protective effect in a wide range of cardiovascular interventions [2][3][4][5]. This discrepancy was also reported in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) [3,[6][7][8][9][10][11][12]. However, some studies reported no effect of body mass index (BMI) on outcomes in patients undergoing TAVI [13,14].…”