Comparison Between Transcatheter and Surgical Aortic Valve Replacement: A Single-Center Experience

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