Comparison of long-term outcomes and risk factors of aortic stenosis treatment in patients undergoing transcatheter aortic valve implantation and surgical aortic valve replacement

Abstract

Background: Aortic stenosis (AS) is the most common valvular heart disease and untreated has a bleak prognosis. The only effective method of treatment is valve replacement, surgical (SAVR), or transcatheter (TAVI). Aims:We decided to analyze outcomes and predictors of long-term mortality in patients undergoing TAVI and SAVR.Methods: A retrospective analysis of 1229 patients with advanced AS, comprising TAVI (n = 211), SAVR (n = 556), SAVR, and additional procedures (n = 462), operated on from 2014 to 2018, was performed.Results: No significant differences between SAVR and TAVI were found for 24-month mortality in groups of consecutive patients. Postoperative stroke or transient ischemic attack (TIA), chronic obstructive pulmonary disease (COPD), and transfusion of red blood cells (RBCs) were independent predictors of 1-year mortality after SAVR. The above-mentioned factors regarding the increased estimated surgery risk in the EuroSCORE II (>4%) were predictors of 2-years mortality after SAVR. Risk factors for 6-and 12-month mortality after TAVI were EuroSCORE II, new onset of atrial fibrillation (NOAF), and the increased RBC distribution width (RDW). Postoperative respiratory failure was an independent risk factor for 6-, 12-and 24-month mortality in both groups of patients.Conclusions: There were no significant differences regarding prognosis after TAVI and SAVR at the 24-month follow-up in the propensity score matching model. Independent predictive factors of late mortality after both procedures were EuroSCORE II and respiratory failure. Independent predictive factors of late mortality specific for TAVI were NOAF, increased RDW, and for SAVR: TIA, stroke, COPD, and RBC transfusion.

Results of aortic valve replacement in aortic stenosis and moderate functional mitral regurgitation

“…Moreover, effective regurgitant orifice area (EROA) >10 mm 2 was previously associated with severe symptoms and higher pulmonary arterial pressure after mixed surgical AVR (SAVR) and transcatheter AVR (TAVI) [23]. TAVI and SAVR patient populations differ much in severity of comorbidities, but reports after TAVI in FMR correspond with SAVR results up to 24 months of follow-up [24][25][26][27].…”

Effectiveness and safety of transcatheter aortic valve replacement in elderly people with severe aortic stenosis with different types of heart failure

“…For patients undergoing surgical aortic valve replacement (SAVR) due to severe aortic stenosis, a reduced left ventricular ejection fraction (LVEF) is associated with increased mortality risk [4]. A reduced EF is one of the commonest reasons for patients being denied access to SAVR [5,6]. Transcatheter aortic valve replacement (TAVR) is now increasingly offered to patients as an alternative to SAVR in patients with symptomatic severe AS and those with intermediate [7,8] or higher [8][9][10][11] surgical risk and has been demonstrated to have comparable outcomes to SAVR.…”

Operative management after transcatheter aortic valve replacement

“…Since its advent in 2002, TAVR has been applied to more than 300 000 patients worldwide and with technical progress, the procedural safety profile is excellent [3][4][5]. However, transcatheter heart valves (THV) suffer from similar long-term complications as surgical heart valve prostheses that require surgical re-intervention, including endocarditis and structural valve deterioration (SVD).…”