Shuli Silberman1, Firas Abu Akr1, Daniel Bitran1, Yaron Almagor2, Jonathan Balkin2, Rachel Tauber1, Ofer Merin1
Departments of 1Cardiothoracic Surgery and 2Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
Background and aim of the study: A comparison was made of the outcomes after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR) in high-risk patients.
Methods: All patients aged >75 years that underwent a procedure for severe aortic stenosis with or without coronary revascularization at the authors’ institution were included in the study; thus, 64 patients underwent TAVI and 188 underwent AVR. Patients in the TAVI group were older (mean age 84 ± 5 versus 80 ± 4 years; p <0.0001) and had a higher logistic EuroSCORE (p = 0.004).
Results: Six patients (9%) died during the procedure in the TAVI group, and 23 (12%) died in the AVR group (p = 0.5). Predictors for mortality were: age
(p <0.0001), female gender (p = 0.02), and surgical valve replacement (p = 0.01). Gradients across the implanted valves at one to three months postoperatively were lower in the TAVI group (p <0.0001). Actuarial survival at one, two and three years was 78%, 64% and 64%, respectively, for TAVI, and 83%, 78% and 75%, respectively, for AVR (p = 0.4). Age was the only predictor for late mortality (p <0.0001).
Conclusion: TAVI patients were older and posed a higher predicted surgical risk. Procedural mortality was lower in the TAVI group, but mid-term survival was similar to that in patients undergoing surgical AVR. Age was the only predictor for late survival. These data support the referral of high-risk patients for TAVI.
The Journal of Heart Valve Disease 2013;22:448-454
|Comparison Between Transcatheter and Surgical Aortic Valve Replacement: A Single-Center Experience|
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