Contemporary short-term outcomes of surgery for aortic stenosis: transcatheter vs. surgical aortic valve replacement

Shunsuke Saito,Yusuke Takei,Koji Ogata,Masahiro Tezuka,Toshimi Sairenchi,Yasushi Tsutsumi,Osamu Monta,Go Tsuchiya,Ikuko Shibasaki,Hirotsugu Fukuda

doi:10.1007/s11748-021-01672-8

Shunsuke Saito, Yusuke Takei + Show 8 more

Open Access

https://doi.org/10.1007/s11748-021-01672-8

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Abstract

ObjectivesThis study aimed to compare the short-term outcomes of transcatheter and surgical aortic valve replacements (TAVR and SAVR) in high-, intermediate-, and low-preoperative risk patients.MethodsA total of 454 patients who underwent TAVR or SAVR were included. Patients were categorized into high-, intermediate-, and low-risk according to the Society of Thoracic Surgery-Predicted Risk of Mortality score and clinical outcomes were compared between TAVR and SAVR groups.ResultsTAVR was less invasive, with less bleeding and transfusion (p < 0.001), less frequent new-onset atrial fibrillation (p < 0.001), and shorter intensive care unit stay (p < 0.001). Furthermore, transcatheter valves performed better than surgical valves, with lower peak velocity (p = 0.003) and pressure gradient (p < 0.001) and higher effective orifice area index (p < 0.001). The clinical outcomes of TAVR were comparable to or even superior to those of SAVR in high- and intermediate-risk patients. In low-risk patients, the 1- and 2-year mortality rates were 6.3% and 12.1%, respectively, in the TAVR group and 0% and 0.9%, respectively, in the SAVR group (p < 0.001). Mild or greater paravalvular leakage was a risk factor for mortality (hazard ratio 35.78; p < 0.001).ConclusionsTAVR was superior to SAVR in the sense of less invasiveness and valvular function. However, the indication of TAVR in low-risk patients should be carefully discussed, because paravalvular leakage was a risk factor for short-term mortality.

Highlights

Surgical aortic valve replacement (SAVR) has long been the gold standard for the surgical treatment of severe aortic stenosis (AS)
There were more female patients in the transcatheter aortic valve replacement (TAVR) group (71.8% vs. 41.2%, p < 0.001), while the body-mass index was lower in the TAVR group (22.1 ± 3.8 kg/m2 vs. 23.3 ± 3.9 kg/m2, p = 0.002)
TAVR transcatheter aortic valve replacement, SAVR surgical aortic valve replacement, STS-PROM Society of Thoracic Surgery-Predicted Risk of Mortality, NYHA New York Heart Association, COPD chronic occlusive pulmonary disease, CABG coronary artery bypass grafting, PCI percutaneous coronary intervention, DMU Dokkyo Medical University diseases were more prevalent in the SAVR group (p < 0.001 and p = 0.020, respectively)

Summary

Introduction

Surgical aortic valve replacement (SAVR) has long been the gold standard for the surgical treatment of severe aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe AS. Two comparative trials among low-risk patients reported promising results [6, 7]. Most guidelines derive their current indications from these industry-driven randomized controlled trials (RCTs) [8, 9]. The results of RCTs have often been criticized because of the limited comparability to “real-world” practice. Before criticizing the RCT outcome, it is essential for us to learn the accurate outcomes of our “real-world” practice in our own country, but real-world data comparing TAVR and SAVR in Japan are scarce [14]. The purpose of the present study was to investigate the preoperative status and clinical outcomes of

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Conclusion