0069 : Early and late outcome after transcatheter aortic valve implantation or surgical aortic valve replacement for high risk patients with aortic stenosis: a monocentric experience

Abstract

Transcatheter Aortic Valve Implantation (TAVI) is an alternative to Surgical Aortic Valve Replacement (SAVR) for high-risk patients. We compared early and 6 years survival rates between TAVI and SAVR and analyzed their predictive factors. We also evaluated the predictive performance of risk scores on 30 days survival rates. Between October 2006 and December 2010, 355 high-risk consecutive patients were admitted to our institution for severe symptomatic aortic stenosis. After Heart Team evaluation, 253 underwent a TAVI and 102 a SAVR. In the TAVI group patients had more comorbidities as assessed by a higher Charlson index (3.8±1,4 vs. 2.8±1,3, p<0.0001). There was no difference on 30-day survival rates between TAVI and SAVR (91±2% and 88±3% respectively; p=0.32). In both groups, predictive factors of 30-day mortality were post-intervention complications illustrated by higher troponin levels (HR 1.01, 95%CI (1.01-1.02) p<0.001 in TAVI group; HR 1.01, 95%CI (1.00- 1.02) p=0.004 in SAVR group) and severe infection (HR 9.77, 95%CI (1.78- 53.61) p=0.009 in TAVI group; HR 4.14, 95%CI (1.21-14.2) p=0.02 in SAVR group). The best risk score for predicting 30-days mortality in TAVI group was the France-2 score (AUC 0.73), while for SAVR it was the STS score (AUC 0.64). During follow-up, most patients died from non-cardiac cause (60% in both groups). The 6-year survival rates were 31±4% and 40±6% for TAVI and SAVR respectively (p=0.03) but the difference was no longer significant after adjustment on the Charlson index (p=0.68). Predictive factors of late mortality were patients’ comorbidities for both groups and paraprosthetic aortic regurgitation ≥2/4 for TAVI (HR 2.05, 95%CI (1.03-4.10), p=0.04). in this single-centre study, there was no difference on 30-day and 6-year survival rates between TAVI and SAVR after adjusting for comorbidities. Late mortality was non-cardiac in the majority of patients. The author hereby declares no conflict of interest