Abstract
Background and Aim: This multi-institutional European study compares the long-term outcome of elderly patients with severe aortic stenosis at intermediate risk profile undergoing sutureless (SV) versus Transcatheter (TAVR) aortic valve implant. Methods: From 2008 to 2015, 967 elderly patients (>75 years old) at intermediate risk (STS score 4%-8%) and isolated aortic stenosis entered the study (SV = 481/TAVR = 486). After full matching Propensity Score, two matched groups of 470 (G1) and 468 (G2) patients were obtained. Primary endpoints included all-causedeath at 30-days and at 5-years. Secondary endpoints included early and 5-years incidence of composite adverse events (MACCEs: all-cause death, stroke, PM implant, MI, paravalvular leak ≥ 2 + , re-operation). Results: After matching there were no difference in major variables between groups. The 30-days mortality was significantly lower in SV group (G1 = 1.7% vs G2 = 6.2%;p = 0.006) as well as permanent PM implantation (G1 = 5.5% vs G2 = 11.7%,p = 0.004). Stroke/TIA cumulative incidence at five years was 1.7% (G1) and 4.8% (G2)(p = 0.020). Incidence of perivalvular leak ≥ grade II was in 0.85% in G1 and 7.4% in G2 (p < 0.001). At mean follow-up of 60 months, overall mortality and the incidence of MACCEs were significantly better in patients undergoing SV (G1 = 14.4 ± 2.7% vs G2 = 30.7 ± 3.3% p < 0.001) (G1 = 20.9 ± 4.9% vs G2 = 43.3 ± 5.1%,p < 0.001). Multivariable Cox Regression identified TAVR as independent predictor for mortality and MACCEs at 5-years (HR = 2.1,CI = 1.12-4.17,p = 0.002) (HR 2.9, CI:1.6-4.3, p < 0,001). Conclusion: Sutureless rapid deployment valves improved the outcomes of aortic stenosis elderly patients at intermediate risk profile. The use of TAVR in this subset population should be evaluated in further controlled randomized trial having sutureless valve as comparative cohort.
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