Conventional versus Transapical Aortic Valve Replacement: Is It Time for Shift in Indications?

Abstract

The incidence of degenerative aortic valve diseases has increased along with the life expectancy of our population. Although conventional aortic valve replacement (AVR) is the gold standard for symptomatic aortic stenosis, transcatheter procedures have proven to be a valid therapeutic option in high-risk patients. The aim of this study was to compare these procedures in a high-risk cohort. We retrospectively analyzed all symptomatic (dyspnea or angina) high-risk patients (logistic EuroSCORE ≥ 15%) fulfilling the transcatheter aortic valve implantation (TAVI) indications. Most of the AVR patients ( = 180) were operated on before the implementation of TAVI. All TAVI procedures ( = 127) were performed transapically (TA). After matching for age, logistic EuroSCORE, and left ventricular ejection fraction, 82 pairs of patients were evaluated. When comparing AVR with TA-TAVI, there was no difference between groups in survival after 1 year (Kaplan-Meier analysis, 81.1% [95% CI: 72.5-89.7%] vs. 75.8% [95% CI: 66.2-75.9%], Log tank = 0.660) and the complication rates ( for AVR vs. TA-TAVI: stroke, 2 vs. 0, = 0.580; acute renal insufficiency, 8 vs. 12, = 0.340; atrial fibrillation, 24 vs. 26, = 0.813; pacemaker implantation, 4 vs. 4, > 0.999). In addition, quality of life did not differ between groups. Patients in the TA-TAVI group had lower mean valvular gradients postoperatively compared with the AVR group (14.6 ± 6.6 vs. 10.2 ± 4.9 mm Hg, < 0.001). For high-risk patients, the TAVI procedure is comparable with conventional AVR, but is not advantageous. These results do not support the expansion of TAVI to low- or intermediate-risk patients.

Alternate Access for TAVI: Stay Clear of the Chest

“…Stroke, pacemaker and indexes of physical and mental quality of life were also similar. 19 However, the five-year mortality in highrisk patients favoured SAVR (HR 1.37; 95 % CI [0.98-1.92]). 20 In the PARTNER 2 trial that randomised intermediate-and low-risk patients, the outcome of the transthoracic approach group (pooling of patients treated through TA and TAo pathways), was found to be non-inferior to SAVR (HR of composite primary outcome including all-cause death and disabling stroke 1.21; 95 % CI [0.84-1.74]).…”

Failed TAVI in TAVI Implantation: TAVI Dislocation Followed by Ensuing Surgical Graft Resection

“…However, TAVI has emerged and proved itself as a credible alternative for high-risk patients and patients in advanced age [1, 13]. The latest meta-analysis had shown the safety and efficacy of TAVI when compared to the standard surgical treatment [14].…”

“…Transcatheter aortic valve implantation (TAVI) is rapidly progressing in becoming a leading treatment for severe aortic stenosis in high-risk or inoperable patients [1]. Over the past years, we had seen an increase in the number of implanted TAVIs, as well as broadening the spectrum for their medical indications [2].…”

Transcatheter Aortic Valve Implantation: Experience of Sainte Clotilde Hospital in Reunion Island

“…The TAVI was developed in the early 2000s, following the work of Alain Cribier's team, a Cardiology department in Rouen, France. As a result, this technique has progressed rapidly to become the treatment of choice for severe aortic stenosis in high-risk or inoperable patients [3]. In recent years, we have seen an increase in the number of TAVI and the broadening of the spectrum of their medical indications [4].…”