Comparison of the surgical and transcatheter aortic valve replacement in high-risk patients

Abstract

Introduction: Transcatheter aortic valve implantation (TAVI) has evolved as an alternative method for surgical valve replacement in high-risk patients. Initially the transfemoral (TF) approach was used, later the transapical (TA) approach was adopted as an option for selected patients. The aim of our study was to compare the safety and anatomical and functional success of TAVI procedures with surgical aortic valve replacement (SAVR).Material and methods: The study included 45 consecutive high-risk patients with symptomatic severe aortic stenosis indicated for aortic valve intervention who met the entry criteria (age >75 years; logistic Euroscore >15%). The patients were allocated to one of three groups according the type of procedure: SAVR (n=15), TAVI TA (n=15) and TAVI TF (n=15). The groups did not differ in their preoperative characteristics except for myocardial infarction, which was more common in the TAVI groups. The Edwards Sapien valve was implanted in the TAVI patients and Edwards Perimount bioprosthesis was used in the SAVR patients. The TA approach was used in patients who were not eligible for the TF approach.Results: All procedures were technically successful. The prostheses used in the SAVR group were smaller in size than those implanted in the TA and TF groups (SAVR, 22.2(21.7;22.8); TA, 24.0(23.6;24.3); TF, 25.0(24.6;25.3)). The TA group patients were exposed to radiation for a shorter period and received a larger amount of contrast medium (TA, 9.7(9.0;10.5)min and 278.3(238.5;318.1)ml; TF, (15.0(13.7;16.4)min, 200.7(179.2;222.1)ml) in TF group). There were no statistically significant differences in the duration of procedures, stay in the intensive care unit and in the hospital, and intra- and post-operative complications among the groups. Early mortality (30 days) was 2.2%. One patient died of clostridium sepsis on day 12 (early mortality, 2.2%). Another patient died due to the multi-organ failure on the 58th day of hospital stay. Five other patients died during one-year follow-up (one-year survival rate, 86.3%). The functional class highly improved in all the patients, of whom 80% were with NYHA classes I or II.Conclusion: Our results show that TAVI is a safe method for treatment of aortic stenosis in high-risk patients and its early results are comparable with surgical aortic valve replacement. The TF and TA approaches are equally efficient, with similar outcomes and complication rates. Provided these results are confirmed at long-term follow-up, it can be assumed that the indication criteria for TAVI approaches will expand.