Two-Year Mortality after Transcatheter Aortic Valve Implantation Versus Medical Therapy for High-Surgical Risk or Inoperable Aortic Stenosis Patients
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Rainer Hoffmann, Bader Almutairi, Ralf Herpertz, Sara Lotfipour, Robert Stöhr, Ömer Aktug, Kathrin Brehmer, Emilia Stegemann, Rüdiger Autschbach, Nikolaus Marx, Guido Dohmen Medical Clinic I and Department of Cardiac and Thoracic Surgery, University RWTH Aachen, Aachen, Germany |
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Background and aim of the study: Transcatheter aortic valve implantation (TAVI) has become a therapeutic option for the treatment of high-risk or inoperable patients with symptomatic severe aortic stenosis. The study aim was to compare the two-year mortality of high-risk or inoperable patients treated by TAVI compared to medical therapy, in a single-center setting. Methods: A total of 135 consecutive patients (58 males, 77 females; mean age 80 ± 6 years; logistic EuroSCORE 21 ± 13%) who had undergone TAVI was compared to 135 patients (60 males, 75 females; mean age 79 ± 3 years; logistic EuroSCORE 21 ± 19%) who had undergone medical treatment before TAVI became available. The one- and two-year follow up mortalities were recorded for each group. In the TAVI group, the patient characteristics were analyzed for predictors of mortality. Results: Sixteen patients (12%) in the TAVI group and 10 (7%) in the medically treated group died within 30 days of intervention or presentation (p = 0.303). At the one-year |
follow up, 28 TAVI patients (21%) and 69 medically treated patients (41%) died (p <0.001). At the two-year follow up, 41 TAVI patients (30%) and 80 medically treated patients (59%) died (p <0.001). Log-rank analysis demonstrated a significant survival benefit after TAVI compared to medical treatment during the total follow up period. Univariate predictors of death at the two-year follow up included medical therapy, logistic EuroSCORE, and pulmonary hypertension. Medical therapy remained the only independent predictor of two-year mortality in a multivariate analysis (OR 3.343; 95% CI 2.021-6.234, p <0.001). Conclusion: In high-surgical risk or inoperable symptomatic aortic stenosis patients, the one- and two-year follow up mortalities of patients treated with TAVI was significantly lower than after medical therapy. Predictors of mortality, in addition to treatment strategy, were pulmonary hypertension and EuroSCORE. |
| Two-Year Mortality after Transcatheter Aortic Valve Implantation Versus Medical Therapy for High-Surgical Risk or Inoperable Aortic Stenosis Patients | |
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