Transcatheter versus Isolated Surgical Aortic Valve Replacement in Young High-Risk Patients: A Propensity Score-Matched Analysis

Mach, Markus; Poschner, Thomas; Hasan, Waseem; Kerbel, Tillmann; Szalkiewicz, Philipp; Hašimbegović, Ena; Andreas, Martin; Gross, Christoph; Strouhal, Andreas; Delle‐Karth, Georg; Grabenwöger, Martin; Adlbrecht, Christopher; Schober, Andreas

doi:10.3390/jcm10153447

Cited by 4 publications

(4 citation statements)

References 28 publications

(49 reference statements)

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“…There have been some propensity-matched studies that shed light on this topic. For instance, a study involving 72 pairs of high-risk patients, although utilizing mixed generations of TAVR valves, showed a lower in-hospital mortality rate but a higher risk of all-cause death at 5-year follow-up in the TAVR group [30]. Another propensity-matched analysis of 783 pairs of intermediate-risk patients (mean age: 81.7 years, mean STS score: 5.5) using newer-generation SAPIEN 3 valves demonstrated a comparable risk of death or disabling stroke at 5 years compared to SAVR [31].…”

Section: Discussionmentioning

confidence: 99%

Long-term and Landmark Analysis of Transcatheter versus Surgical Aortic-Valve Replacement in Severe Aortic Stenosis

Zhang,

Kang,

Wang

et al. 2023

Preprint

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BackgroundPrevious reports of long-term outcomes of TAVR focus on higher risk patients and suggest potential temporal changes. The indications of TAVR have expanded to low-risk patients. We aimed to evaluate the long-term and temporal performances of transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR).MethodsRandomized controlled trials reporting outcomes with at least 1-year follow-up were included. The primary outcome was the composite of all-cause death or disabling stroke.ResultsWe included 8 trials with 8,749 patients. TAVR was associated with a higher risk of long-term (5-year) primary outcome compared to SAVR among higher-risk (odds ratio [OR], 1.25; 95% CI, 1.07–1.47) but not lower-risk participants (1.0 [0.77–1.29]). However, a significant temporal interaction was detected in both risk profiles. TAVR with balloon-expandable valves was associated with a higher risk of long-term primary outcome compared to SAVR (1.38 [1.2–1.6]), whereas no statistical difference was found with self-expanding valves (1.03 [0.89–1.19]). There was a significant interaction between the two valve systems, and a temporal interaction was detected in both systems. Overall landmark analysis revealed a lower risk in TAVR within the initial 30 days (0.76 [0.6, 0.96]), comparable between 30 days to 2 years (1.04 [0.85, 1.28]), and higher beyond 2 years (1.36 [1.15– 1.61]). Analysis for all-cause death generated largely similar results.ConclusionsTAVR was associated with a higher long-term risk of primary outcome compared to SAVR in higher-risk patients and with balloon-expandable valves. However, a characteristic temporal interaction was documented in all subgroups. Future studies are warranted to test these findings.

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Section: Discussionmentioning

confidence: 99%

Long-term and Landmark Analysis of Transcatheter versus Surgical Aortic-Valve Replacement in Severe Aortic Stenosis

Zhang,

Kang,

Wang

et al. 2023

Preprint

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“…A study done in 2021 by Virgili et al 4 showed that SAVR is the go‐to for the younger population because they are typically better surgical candidates. In addition, a study by Mach et al 16 showed that although short‐term survival (30 days postoperative) is higher in younger patients undergoing TAVR, SAVR was associated with better long‐term survival. TAVR would be ideal for all ages given its less invasive nature and lower complication rate.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study on the trends in surgical aortic valve replacement outcomes in the post‐transcatheter aortic valve replacement era

Chahine

Jedeon

Fiocchi

et al. 2022

Health Science Reports

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Background and Aims: Transcatheter aortic valve replacement (TAVR) is the mainstay of treatment of inoperable and severe high-risk aortic stenosis and is noninferior to surgical aortic valve replacement (SAVR) for low-risk and intermediate-risk patients as well. We aim to compare the valve size, area, and transaortic mean gradients in SAVR patients before and after the implementation of TAVR since being approved by the Food and Drug Administration in 2011. Methods: Patients who underwent a bioprosthetic SAVR placement were divided into two groups based on the date of procedure: the early pre-TAVR implementation group (years 2011-2012) and the contemporary post-TAVR group (years 2019-2020). The primary endpoint was the mean gradient across the aortic valve within 16 months of surgery. The secondary endpoints included the difference in valve size and various aortic valve echocardiographic variables. Results: One hundred and thirty patients had their valves replaced in the years 2011-2012 and 134 in the years 2019-2020. The early group had a significantly higher mean gradient (median of 13 mmHg [interquartile range, IQR: 9.3-18] vs. 10 mmHg [IQR: 7.5-13.1], p = 0.001) and a smaller median effective orifice area index (0.8 cm 2 /m 2 [IQR: 0.6-1] vs. 1.1 cm 2 /m 2 [IQR: 0.8-1.3], p < 0.001). The median valve size was significantly smaller in the early group (median of 21 mm [IQR: 21-23] vs. 23 mm [IQR: 22.5-25], p < 0.001). Conclusion:In the contemporary era, surgical patients receive larger valves which translates into lower mean gradients, larger valve area, and lower rates of patientprosthesis mismatch than in previous years before the routine introduction of TAVR.

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“…Mach, M et al (2021) 10 showed Although the survival analysis revealed a higher in-hospital and 30-day survival rate for high-risk patients aged ≤75 years who underwent TAVR, iSAVR was associated with a significantly higher long-term survival rate.…”

Section: Austriamentioning

confidence: 99%

Comparison of Alternative Peripheral and Transcatheter Aortic Valve Replacement : Systematic Review

Sabri,

Nasution,

Namora Siregar

et al. 2023

JARMHS

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Background: Transcatheter aortic valve replacement (TAVR) is approved for use in low-to-extreme-risk patients with aortic stenosis, with volumes exceeding those of surgical aortic valve replacement and outcomes continuing to improve. The transfemoral (TF) access route is accepted as the first choice for TAVR and accounts for 95 of cases. However, the use of alternative access remains relevant in many patients with peripheral vascular disease or unfavorable anatomy. The aim: This study aims to show about comparison of alternative peripheral and transcatheter aortic valve replacement. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 135 articles, whereas the results of our search on SagePub brought up 118 articles. The results of the search conducted for the last year of 2013 yielded a total 56 articles for PubMed and 33 articles for SagePub. The result from title screening, a total 16 articles for PubMed and 10 articles for SagePub. In the end, we compiled a total of 8 papers. We included five research that met the criteria. Conclusion: To compare outcomes among transcatheter aortic valve replacement (TAVR) performed via transaortic (TAo) and subclavian (SCL) approaches. Many patients are not amenable for TAVR via the transfemoral route due to peripheral vascular disease. Limited data exist regarding safety and procedural feasibility of TAVR via TAo and SCL routes.

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Transcatheter versus Isolated Surgical Aortic Valve Replacement in Young High-Risk Patients: A Propensity Score-Matched Analysis

Cited by 4 publications

References 28 publications

Long-term and Landmark Analysis of Transcatheter versus Surgical Aortic-Valve Replacement in Severe Aortic Stenosis

Long-term and Landmark Analysis of Transcatheter versus Surgical Aortic-Valve Replacement in Severe Aortic Stenosis

A retrospective study on the trends in surgical aortic valve replacement outcomes in the post‐transcatheter aortic valve replacement era

Comparison of Alternative Peripheral and Transcatheter Aortic Valve Replacement : Systematic Review

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