Comparison of Survival of Transfemoral Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement for Aortic Stenosis in Low-Risk Patients Without Coronary Artery Disease - 25/01/20

Doi : 10.1016/j.amjcard.2019.11.002

Marko P.O. Virtanen, MD ^a, Juhani Airaksinen, MD, PhD ^b, Matti Niemelä, MD, PhD ^c, Teemu Laakso, MD ^d, Annastiina Husso, MD, PhD ^e, Maina P. Jalava, MD ^b, Tuomas Tauriainen, MD, PhD ^f, Pasi Maaranen, MD ^a, Eeva-Maija Kinnunen, MD, PhD ^d, Sebastian Dahlbacka, MD, PhD ^d, Stefano Rosato, MSc ^g, Mikko Savontaus, MD, PhD ^b, Tatu Juvonen, MD, PhD ^d, Mika Laine, MD, PhD ^d, Timo Mäkikallio, MD, PhD ^c, Antti Valtola, MD, PhD ^e, Peter Raivio, MD, PhD ^d, Markku Eskola, MD, PhD ^a, Fausto Biancari, MD, PhD ^b,^f,^⁎
^a Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
^b Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland
^c Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
^d Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
^e Heart Center, Kuopio University Hospital, Kuopio, Finland
^f Department of Surgery, Oulu University Hospital and Research Unit of Surgery, Anesthesia and Intensive Care, Faculty of Medicine, University of Oulu, Oulu, Finland
^g National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy

^⁎Corresponding author: Tel: 358407333973.

Résumé

Increasing data support transcatheter aortic valve implantation (TAVI) as a valid option over surgical aortic valve replacement (SAVR) in the treatment for severe aortic stenosis (AS) also in patients with low operative risk. However, limited data exist on the outcome of TAVI and SAVR in low-risk patients without coronary artery disease (CAD). The FinnValve registry included data on 6463 patients who underwent TAVI or SAVR with bioprosthesis between 2008 and 2017. Herein, we evaluated the outcome of low operative risk as defined by STS-PROM score <3% and absence of CAD, previous stroke and other relevant co-morbidities. Only patients who underwent TAVI with third-generation prostheses and SAVR with Perimount Magna Ease or Trifecta prostheses were included in this analysis. The primary endpoints were 30-day and 3-year all-cause mortality. Overall, 1,006 patients (175 TAVI patients and 831 SAVR patients) met the inclusion criteria of this analysis. Propensity score matching resulted in 140 pairs with similar baseline characteristics. Among these matched pairs, 30-day mortality was 2.1% in both TAVI and SAVR cohorts (p = 1.00) and 3-year mortality was 17.0% after TAVI and 14.6% after SAVR (p = 0.805). Lower rates of bleeding and atrial fibrillation, and shorter hospital stay were observed after TAVI. The need of new permanent pacemaker implantation and the incidence of early stroke did not differ between groups. In conclusion, TAVI using third-generation prostheses achieved similar early and mid-term survival compared with SAVR in low-risk patients without CAD.

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	Sources of funding and support: This study was not supported by any external funding.
	Clinical trial registration: ClinicalTrials.gov Identifier: NCT03385915.

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Vol 125 - N° 4

P. 589-596 - février 2020 Retour au numéro

Article précédent

Effectiveness and Safety of Transcatheter Aortic Valve Implantation in Patients With Aortic Stenosis and Variable Ejection Fractions (<40%, 40%-49%, and >50%)
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Comparison of Survival of Transfemoral Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement for Aortic Stenosis in Low-Risk Patients Without Coronary Artery Disease - 25/01/20

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