Transcatheter Aortic Valve Implantation versus Surgical Aortic Valve Replacement in Low-Risk Patients: A Propensity Score Matched Analysis

Schaefer, Arnd; Schofer, Niklas; Goßling, Alina; Schirmer, Johannes; Deuschl, Florian; Schneeberger, Y.; Blankenberg, Stefan; Reichenspurner, H.; Schäfer, Ulrich; Conradi, L.

doi:10.1055/s-0039-1678877

Cited by 6 publications

(22 citation statements)

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“…However, significantly more PVL was observed in the TAVI group (PVL ≥ 2: 7.7 vs 0.9%, P = .02) . A Kaplan‐Meier survival analysis conducted presented similar 1‐ and 5‐year survival rates for TAVI and SAVR patients …”

Section: Tavi In Low‐risk Patientsmentioning

confidence: 76%

“…The study concluded that TAVI and SAVR had comparable outcomes for these lower‐risk patients. Outcomes after 30 days from procedures showed no significant differences in terms of mortality (TAVI 2/114 vs SAVR 2/114, P = 1.0), acute kidney injury (8/114 vs 3/114, P = .35), stroke (3/114 vs 3/114, P = 1.0), or PPM (16.8 vs 8.5%, P = .12) . Review of the hemodynamic outcomes demonstrated comparable performance of the valves regarding postprocedural transvalvular pressure gradients (pmax: 21.0 vs 20.0 mm Hg, P = .8; pmean: 10.0 vs 11.0 mm Hg, P = .7).…”

Section: Tavi In Low‐risk Patientsmentioning

confidence: 97%

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TAVI and the future of aortic valve replacement

et al. 2019

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Aortic valve stenosis (AS) is the most common valvular pathology and has traditionally been managed using surgical aortic valve replacement (SAVR). A large proportion of affected patient demographics, however, are unfit to undergo major surgery given underlying comorbidities. Since its introduction in 2002, transcatheter aortic valve implantation (TAVI) has gained popularity and transformed the care available to different-risk group patients with severe symptomatic AS. Specific qualifying criteria and refinement of TAVI techniques are fundamental in determining successful outcomes for intervention. Given the successful applicability in high-risk patients, TAVI has been further developed and trialed in intermediate and low-risk patients. Within intermediate-risk patient groups, TAVI was shown to be noninferior to SAVR evaluating 30-d mortality and secondary endpoints such as the risk of bleeding, development of acute kidney injury, and length of admission. The feasibility of expanding TAVI procedures into low-risk patients is still a controversial topic in the literature. A number of trials have recently been published which demonstrate TAVI as noninferior and even superior over SAVR for primary study endpoints. K E Y W O R D S aortic valve, surgery, TAVI, valve replacement 1 | INTRODUCTION Aortic valve stenosis (AS) is the most common valvular pathology, with between 2% and 4% of patients over the age of 75 years bring affected. 1 For decades, surgical aortic valve replacement (SAVR) has been considered the class I recommendation in the management of AS. 2 However, given that advanced age, frailty, and significant comorbidities are increasingly prevalent in affected patients; more than one-third of high-risk and severe symptomatic AS patients were not considered physiologically fit enough for major surgical intervention. 2,3 This merited the development of TAVI, an intervention suitable for high-risk patients and those deemed unfit for surgery. With a shift in clinical paradigm toward minimally invasive procedures, the development of TAVI has revolutionized clinical outcomes in AS, particularly in those once considered inoperable. 4 The decision to use TAVI vs SAVR for aortic valve replacement (AVR) is determined by clinical, anatomical, and technical considerations. Since its introduction in 2002, 5 TAVI has increasingly replaced SAVR, the once considered gold standard treatment, in aortic valve diseases. 6-10 More recently, trials such as the Placement of Aortic Trans-Catheter Valve II (PARTNER II) and Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) 11,12 have further established the use of TAVI in intermediate-risk patients as well. Given this validation of TAVI within high-and intermediate-risk patients, a need has now developed to evaluate the clinical efficacy of TAVI within low-risk surgical candidates. 13Selective candidate criteria, as well as advances in operative techniques within TAVI, are mainstay contributors to successful outcomes. Fundamentally, there exist both retrogr...

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Section: Tavi In Low‐risk Patientsmentioning

confidence: 76%

Section: Tavi In Low‐risk Patientsmentioning

confidence: 97%

TAVI and the future of aortic valve replacement

et al. 2019

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“…The indications for TAVR are expanding, but it is controversial whether TAVR should be performed on a larger scale because of limited data on the long-term outcome and valve durability of TAVR prostheses compared to SAVR prostheses. Similar longer-term survival after TAVR and SAVR is observed in randomized controlled trials [1,6,7], but studies reporting outcomes in the realworld populations have discordant findings [9][10][11][12]. Sustained valve hemodynamics and low reintervention rate is associated with the use of first-generation balloon-expandable Sapien bioprosthesis [1,13].…”

Section: Introductionmentioning

confidence: 85%

Mid-term outcomes of Sapien 3 versus Perimount Magna Ease for treatment of severe aortic stenosis

Virtanen

Eskola

Savontaus

et al. 2020

J Cardiothorac Surg

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Background: There is limited information on the longer-term outcome after transcatheter aortic valve replacement (TAVR) with new-generation prostheses compared to surgical aortic valve replacement (SAVR). The aim of this study was to compare the mid-term outcomes after TAVR with Sapien 3 and SAVR with Perimount Magna Ease bioprostheses for severe aortic stenosis. Methods: In a retrospective study, we included patients who underwent transfemoral TAVR with Sapien 3 or SAVR with Perimount Magna Ease bioprosthesis between January 2008 and October 2017 from the nationwide FinnValve registry. Propensity score matching was performed to adjust for differences in the baseline characteristics. The Kaplan-Meir method was used to estimate late mortality. Results: A total of 2000 patients were included (689 in the TAVR cohort and 1311 in the SAVR cohort). Propensity score matching resulted in 308 pairs (STS score, TAVR 3.5 ± 2.2% vs. SAVR 3.5 ± 2.8%, p = 0.918). In-hospital mortality was 3.6% after SAVR and 1.3% after TAVR (p = 0.092). Stroke, acute kidney injury, bleeding and atrial fibrillation were significantly more frequent after SAVR, but higher rate of vascular complications was observed after TAVR. The cumulative incidence of permanent pacemaker implantation at 4 years was 13.9% in the TAVR group and 6.9% in the SAVR group (p = 0.0004). At 4-years, all-cause mortality was 20.6% for SAVR and 25.9% for TAVR (p = 0.910). Fouryear rates of coronary revascularization, prosthetic valve endocarditis and repeat aortic valve intervention were similar between matched cohorts. Conclusions: The Sapien 3 bioprosthesis achieves comparable midterm outcomes to a surgical bioprosthesis with proven durability such as the Perimount Magna Ease. However, the Sapien 3 bioprosthesis was associated with better early outcome. Trial registration: ClinicalTrials.gov Identifier: NCT03385915.

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“…While durability of tissue valves may be one explanation for this possible difference at 5 years, one summary of the available information 41 and one outcome study of the NOTION trial illustrated that signs for structural valve deterioration were even lower in the TAVI population, although the rates of valve failure were low and the same in both groups. 42 Thus, the differences in mortality observed in several studies 39,40,43,44 may not be explained by differences in midterm durability.…”

Section: The Role Of Medical Therapy In Cabg Patientsmentioning

confidence: 94%

“…39 Finally, a single-center propensity-matched comparison in low-risk patients (109 pairs, EuroSCORE II < 4%) suggested similar outcomes between TAVI and SAVR at 1 year, but a remarkable (and significant) survival advantage for SAVR after 5 years. 40 Thus, longer follow-up appears necessary.…”

Section: The Role Of Medical Therapy In Cabg Patientsmentioning

confidence: 99%

Cardiac Surgery 2019 Reviewed

Doenst

Bargenda

Kirov

et al. 2020

Thorac Cardiovasc Surg

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For the year 2019, almost 25,000 published references can be found in PubMed when entering the search term “cardiac surgery.” We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach for article selection and reviewed the main fields of adult cardiac surgery (i.e., coronary, valve, aortic, and heart failure surgery). The past decade has experienced an enormous development of interventional techniques that compete more and more with classic surgery. This contest was broadly visible in 2019. It peaked over the interpretation of the EXCEL trial data, where percutaneous coronary intervention and coronary artery bypass grafting (CABG) for left main disease were compared. A novel pathomechanism for CABG was proposed, potentially answering open questions in the field. In aortic valve surgery, two low-risk trials comparing transcatheter aortic valve implantation (TAVI) to classic aortic valve replacement (surgical aortic valve replacement) received attention for showing equal or superior short-term outcomes for TAVI. Longer follow-up information from recent trials became available presenting results emphasizing the need for joint decision making. While publications addressing surgery on the aorta and the mitral and tricuspid valves were less abundant, there was substantial activity regarding left ventricular assist device support and heart transplantation. This article attempts to summarize the most pertinent publications. It does not expect to be complete and cannot be free of individual interpretation. We aimed to provide a condensed summary of 2019s publications with a stimulus for in-depth reading and a basis supporting patient information.

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Transcatheter Aortic Valve Implantation versus Surgical Aortic Valve Replacement in Low-Risk Patients: A Propensity Score Matched Analysis

Cited by 6 publications

References 0 publications

TAVI and the future of aortic valve replacement

TAVI and the future of aortic valve replacement

Mid-term outcomes of Sapien 3 versus Perimount Magna Ease for treatment of severe aortic stenosis

Cardiac Surgery 2019 Reviewed

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