Surgical versus transcatheter aortic valve replacement in low‐risk patients: A long‐term propensity score‐matched analysis

Abstract

Background Recent studies suggest the use of transcatheter aortic valve implantation (TAVI) as an alternative to surgical aortic valve replacement (SAVR) in lower risk populations, but real‐world data are scarce. Methods Single‐center retrospective study of patients undergoing SAVR (between June 2009 and July 2016, n = 682 patients) or TAVI (between June 2009 and July 2017, n = 400 patients). Low surgical risk was defined as EuroSCORE II (ES II) < 4% for single noncoronary artery bypass graft procedure. TAVI patients were propensity score‐matched in a 1:1 ratio with SAVR patients, paired by age, New York Heart Association class, diabetes mellitus, chronic obstructive pulmonary disease, atrial fibrillation, creatinine clearance, and left ventricular ejection fraction < 50%. Results A total of 158 patients (79 SAVR and 79 TAVI) were matched (mean age 79 ± 6 years, 79 men). TAVI patients had a higher incidence of permanent pacemaker implantation (0% vs. 19%, p < 0.001) and more than mild paravalvular leak (4% vs. 18%, p = 0.009), but comparable rates of stroke, major or life‐threatening bleeding, emergent cardiac surgery, new‐onset atrial fibrillation, and need for renal replacement therapy. Hospital length‐of‐stay and 30‐day mortality were similar. At a median follow‐up of 4.5 years (IQR 3.0–6.9), treatment strategy did not influence all‐cause mortality (HR 1.19, 95% CI 0.77–1.83, log rank p = 0.43) nor rehospitalization (crude subdistribution HR 1.56, 95% CI 0.71–3.41, p = 0.26). ES II remained the only independent predictor of long‐term all‐cause mortality (adjusted HR 1.40, 95% CI 1.04–1.90, p = 0.029). Conclusion In this low surgical risk severe aortic stenosis population, we observed similar rates of 30‐day and long‐term all‐cause mortality, despite higher rates of permanent pacemaker implantation and more than mild paravalvular leak in TAVI patients. The results of this small study suggest that both procedures are safe and effective in the short‐term, while the Heart Team remains essential to assess both options on the long‐term.

Long-Term Outcomes After Transcatheter Aortic Valve Replacement: Meta-Analysis of Kaplan-Meier-Derived Individual Patient Data

“…The copyright holder for this preprint this version posted March 24, 2023. ; https://doi.org/10.1101/2023.03.20.23287505 doi: medRxiv preprint survival analysis [11,[13][14][15][16][17][18][19][20][21][22]. One study was a randomized controlled trial and remaining ten studies were observational.…”

“…A total of 11,987 studies were identified, published from 2002 to 2016, after removal of duplicates and evaluation based on the selection criteria, 12 studies were included in the meta-analysis (Figure 1). Eleven studies with a total of 5,458 patients were included in the survival analysis [11,[13][14][15][16][17][18][19][20][21][22]. One study was a randomized controlled trial and remaining ten studies were observational.…”

Long‐term outcomes after transcatheter aortic valve replacement: Meta‐analysis of Kaplan−Meier‐derived data

“…Eleven studies with a total of 5458 patients were included in the survival analysis. 11,[13][14][15][16][17][18][19][20][21][22] One study was a randomized controlled trial and remaining 10 studies were observational. Five studies with 1509 patients were included in the analysis of freedom from SVD.…”

“…A total of 11,987 studies were identified, published from 2002 to 2016, after removal of duplicates and evaluation based on the selection criteria, 12 studies were included in the meta‐analysis (Figure 1). Eleven studies with a total of 5458 patients were included in the survival analysis 11,13–22 . One study was a randomized controlled trial and remaining 10 studies were observational.…”