Comparing outcomes between surgical aortic valve replacement and transcatheter aortic valve implantation

Transcatheter aortic valve implantation (TAVI) has been introduced for the treatment of high-risk patients with symptomatic aortic stenosis. Surgical aortic valve replacement (SAVR) provides the therapeutic armamentarium for all complex valvular pathologies and is the established gold standard. TAVI has initially been restricted to non-operable patients. The extension of this treatment modality to less complex patient populations warrants a thorough comparison of safety and efficacy vis-a-vis SAVR. Perioperative mortality of SAVR for high-risk subpopulations such as octogenarians, patients with impaired LV function or previous sternotomy ranges from 5 to 19%. Peri-interventional mortality rates for TAVI amount to 6–23%. Reported stroke rates average 2–5% with both treatment modalities. While TAVI does not require cardiopulmonary bypass or general anesthesia, the spectrum of peri-interventional complications is extended to vascular access site complications as well as atrioventricular conductance disturban...