Transcatheter versus minimally invasive surgical aortic valve replacement with rapid-deployment valves: a propensity-matched analysis

OBJECTIVES This study evaluates intermediate-term survival and valve related complications in patients undergoing minimally invasive surgical aortic valve replacement (MI-SAVR) using rapid-deployment (RD) valves compared with those receiving transfemoral transcatheter aortic valve replacement (TF-TAVR) after propensity matched analysis. METHODS All consecutive patients treated with either isolated MI-SAVR with a RD valve or TF-TAVR at a single cardiac-surgery center were retrospectively reviewed. A propensity score was created and exact matching after maximum propensity score difference was applied. Nearest-neighbor matching was conducted with a caliper of 0.2 standard deviations of the logit of the propensity score, without replacement and with a 1:1 matching ratio. RESULTS From April 2011 to June 2022, 926 patients underwent either isolated MI-SAVR with a RD valve (n = 400) or TF-TAVR (n = 526). After propensity score matching the final cohort (n = 366) included 183 matched pairs. Operative mortality was 0% after MI-SAVR compared with 3.3% (n = 6) following TF-TAVR (p = 0.03). Perioperative stroke occurred in 2.7% (n = 5, MI-SAVR) vs 2.2% (n = 4, TF-TAVR, p = 1). At 3-years, MI-SAVR was associated with significant lower rates of paravalvular leakage (2.2 vs 13.8%, p < 0.001), new pacemaker implantations (6.6 vs 14.8%, p = 0.01) and a composite end-point of thromboembolic and major bleeding events (7.2% vs 12.7%, p = 0.025). No difference between aortic valve re-interventions and stroke were identified between groups. Survival at 1- and 3-years follow-up was 98% and 88% (MI-SAVR) and 88% and 67% (TF-TAVR) respectively (p < 0.001). EuroScore II emerged as an independent predictor of mortality (HR 1.12 [1.02, 1.23], p = 0.014). CONCLUSIONS Minimally invasive SAVR with RD-valves could represent a treatment modality to TF-TAVR for severe AS in an older, low-risk patient cohort. In our retrospective cohort study MI-SAVR was linked to improved survival and lower rates of permanent pacemaker implantation and paravalvular leakage.