Response to Letters Regarding Article, “Comparison Between Transcatheter and Surgical Prosthetic Valve Implantation in Patients With Severe Aortic Stenosis and Reduced Left Ventricular Ejection Fraction”

Abstract

We thank Subramanian et al and Ranucci et al for their insightful comments with regard to our study.1 In response to the comments of Ranucci et al, we provide the following statements. 1. The important variability in the 30-day mortality rates (8% to 33%) reported in previous studies is essentially related to the differences in the cutoff values used for the left ventricular ejection fraction (LVEF), but also, and more importantly, it is related to the differences in the baseline risk profile of the study populations. The fact that the mortality (12%) observed in our surgical aortic valve replacement (SAVR) series is higher than that (8% to 10%) of some previous series is essentially related to the worse-risk profile of the patients included in this series. 2. The assessment of SAVR operative risk was based on a comprehensive analysis of the factors included in the risk scores, and those (eg, frailty) not included in these scores, as well. All patients included in the transcatheter aortic valve implantation (TAVI) series had been refused for SAVR by at least 2 cardiac surgeons. 3. We agree that the presence of reduced LVEF should not be used as the sole argument to recommend TAVI rather than SAVR in patients with severe aortic stenosis. SAVR remains the standard of care in the vast majority of patients with reduced LVEF and high …