Surgical or Transcatheter Aortic-Valve Replacement

Noble, Stéphane; Burri, Haran; Roffi, Marco

doi:10.1056/nejmc1706234

Cited by 21 publications

(11 citation statements)

References 14 publications

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“…11 In the SURTAVI randomized trial, which also comprised intermediate-risk patients, TAVI proved to be non-inferior to SAVR with respect to death from any cause or disabling stroke at 24 months. 6 However, for many reasons, the results from randomized trials usually do not reflect, the “real-world” population.…”

Section: Discussionmentioning

confidence: 99%

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Transcatheter Versus Surgical Valve Replacement: A 24-months Propensity-matched Analysis of the SILCARD Registry

Wilczek

Hawranek

Wojakowski

et al. 2022

Anatolian J Cardiol

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Background Data concerning the comparison between transcatheter aortic valve implantation and surgical aortic valve replacement in a real-world setting are scarce and in Central and Eastern Europe no such data exist. In this study, we aimed at analyzing retrospectively the characteristics and outcome of patients with aortic stenosis treated either with surgical aortic valve replacement or transcatheter aortic valve implantation between 2006 and 2016 in the Silesian Province, Poland in a representative real-world cohort. Methods In the Silesian Cardiovascular Database we retrospectively identified 5186 patients who received either transcatheter aortic valve implantation or surgical aortic valve replacement in 1 of 3 tertiary cardiovascular centers. Baseline characteristics, including relevant clinical history, and outcomes were compared before and after propensity-score matching of both groups, with 348 pairs of patients constituting the propensity-matched study cohort. The primary end-point was 24-month all-cause mortality. Results Preoperative characteristics of propensity-matched groups were similar. There was no difference between transcatheter aortic valve implantation and surgical aortic valve replacement groups with respect to the death rate at 2 years (19.9% vs. 15.6%; P = .479). In the transcatheter aortic valve implantation group, cardiac resynchronization therapy devices were more frequently implanted after the procedure (3.7% vs. 0.0, P < .001). The groups had similar rates of myocardial infarction, stroke, and re-hospitalization. Hospital stay in the matched groups was shorter after transcatheter aortic valve implantation: 14.1 versus 15.7 days ( P < .001). Conclusions At 24 months, transcatheter aortic valve implantation patients had similar outcomes as surgical aortic valve replacement except for a higher rate of cardiac resynchronization therapy device implantation and shorter hospital stay.

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Section: Discussionmentioning

confidence: 99%

“… 4 , 5 The results of the recently published SURTAVI randomized trial comparing SAVR with TAVI in intermediate-risk patients justify the wider use of TAVI in this subpopulation of AS patients. 6 …”

Section: Introductionmentioning

confidence: 99%

Transcatheter Versus Surgical Valve Replacement: A 24-months Propensity-matched Analysis of the SILCARD Registry

Wilczek

Hawranek

Wojakowski

et al. 2022

Anatolian J Cardiol

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“…Legitimate concerns regarding the clinical efficacy and safety of early discharge have been raised with previous authors. 11 -17,21 Results from recent studies have shown that clinical endpoints compare favorably with that of contemporary trials and registries. Our study showed that among patients discharged home ≤3 days after TAVR, the trends in procedural costs after PLOS of 0 to 1, 2, and 3 days did not change significantly at the latter parts of 2017.…”

Section: Discussionmentioning

confidence: 99%

Trends in Early Discharge and Associated Costs after Transcatheter Aortic Valve Replacement: A National Perspective

Okoh

Siddiqui

Soto

et al. 2021

Innovations�(Phila)

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Objective The current study aims to report trends of early discharges and identify associated direct costs using a nationally representative database of real-world data experience. Methods We used nationally weighted data on all patients who had transfemoral transcatheter aortic valve replacement (TAVR) from 2012 to 2017 and discharged alive from the National Inpatient Sample. Patients were divided into early (discharge ≤3 days of admission) and late discharge. Demographics and clinical characteristics were compared. Trends in early discharge and costs associated with admissions were analyzed over the study period. Results Of the 125,188 patients identified, 59,424 (46.9%) were discharged early. The proportion of early discharge increased from 15% in early 2012 to 68% in late 2017 ( P < 0.001), with the largest increase occurring from 2014 to 2015. Overall, the average cost of TAVR decreased from $58,408 in 2012 to $49,875 in 2017 ( P < 0.001). Compared to late discharge, patients discharged early reported costs savings of ≥$20,000 over the study period. Among the early discharge group, no significant differences in costs were observed for patients discharged on 0 to 1, 2, or 3 days after the procedure. Conclusions Postoperative length of stay after TAVR has decreased dramatically within the last decade with an observed reduction in procedural costs. While discharge within 3 days appeared cost effective, no differences in costs were noted among patients discharged ≤3 days.

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“…The American and European valve guidelines’ recommendations regarding aortic valve replacement (AVR) in the setting of AS do not differentiate between those with and without CKD 25 26. Among all-comers with symptomatic, severe AS, AVR improves survival, symptoms and LV systolic function 25 27–34. While the data for AVR outcomes for patients with severe CKD are more limited, in one study of 839 patients with CKD stage 3 or 4 and AS of varying severity, 156 patients (19%) underwent AVR (96% surgical aortic valve replacement (SAVR) and 4% transcatheter aortic valve implantation (TAVI)) 12.…”

Section: Patient Casementioning

confidence: 99%

“…There have been no RCTs directly comparing TAVI with SAVR in CKD. Although approximately 60% of patients in the PARTNER and CoreValve US Pivotal Trials had CKD, those with eGFR <20 mL/m 2 /1.73 m 2 or on haemodialysis were excluded 30–34. A subgroup analysis of the CoreValve US Pivotal High-Risk Trial of 3-year follow-up for patients with CKD stages 3–4 found that for TAVI versus SAVR, there was no difference in mortality or stroke, although TAVI had lower rates of acute kidney injury (AKI) and life-threatening bleeding but higher rates of major vascular complications and need for pacemaker implantation.…”

Section: Patient Casementioning

confidence: 99%

Aortic stenosis in chronic kidney disease: challenges in diagnosis and treatment

Gupta

Gualano

Bhave

2021

Heart

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Chronic kidney disease (CKD) is becoming increasingly common and is associated with development and rapid progression of aortic stenosis (AS). Patients with AS and CKD have higher mortality rates than those with AS of similar severity and normal kidney function. The diagnosis of severe AS in patients with CKD is often challenging due to alterations in haemodynamics and heart structure, and integration of data from multiple imaging modalities may be required. When indicated, the definitive treatment for severe AS is aortic valve replacement. Patients with CKD are candidates for bioprosthetic valve replacement (surgical or transcatheter aortic valve implantation) or mechanical valve replacement. However, for patients with CKD, lifetime management is complex, as patients with CKD have a higher competing risk of bioprosthetic structural valve deterioration, bleeding in the setting of systemic anticoagulation and mortality related to CKD itself. The involvement of a heart-kidney multidisciplinary team in the care of patients with CKD and severe AS is ideal to navigate the complexities of diagnosis and management decisions.

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Surgical or Transcatheter Aortic-Valve Replacement

Cited by 21 publications

References 14 publications

Transcatheter Versus Surgical Valve Replacement: A 24-months Propensity-matched Analysis of the SILCARD Registry

Transcatheter Versus Surgical Valve Replacement: A 24-months Propensity-matched Analysis of the SILCARD Registry

Trends in Early Discharge and Associated Costs after Transcatheter Aortic Valve Replacement: A National Perspective

Aortic stenosis in chronic kidney disease: challenges in diagnosis and treatment

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