Key result
Transcatheter aortic valve replacement was associated with similar overall operative mortality but better mid-term survival compared to intermediate- or high-risk surgical aortic valve replacement in patients with previous chest-directed radiation therapy.
Why the study?
Cardiac surgery for radiation-induced valvular disease is associated with adverse outcomes, while TAVR is increasingly used in patients with prior chest radiation and aortic stenosis.
Does TAVR improve survival and reduce postoperative morbidities compared with SAVR in patients with previous chest-directed radiation therapy and aortic stenosis?
Cohort (n=186)
No
Does TAVR improve survival and reduce postoperative morbidities compared with SAVR in patients with previous chest-directed radiation therapy and aortic stenosis?
Answers are grounded in this paper and cite their sources.
TAVR is associated with better survival and shorter hospital stays compared to intermediate/high-risk SAVR in patients with radiation-induced aortic stenosis.
BACKGROUND: Cardiac surgery for radiation-induced valvular disease is associated with adverse outcomes. Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with a history of chest-directed radiation therapy and aortic stenosis (CRT-AS). OBJECTIVES: We examined outcomes of TAVR compared with surgical aortic valve replacement (SAVR) for patients with CRT-AS. METHODS: We identified 69 patients with CRT-AS who underwent TAVR from January 2012 to September 2018. Operative mortality, postoperative morbidities, and length of hospitalization were compared with 117 contemporaneous patients with CRT-AS who underwent isolated SAVR. Age-adjusted survival was evaluated by means of Cox proportional hazards modeling. The ratio of observed to expected mortality was better for low-risk SAVR patients and all TAVR patients (0.72 [95% confidence interval [CI]: 0.59-0.86] and 0.24 [95% CI: 0.05-0.51], respectively) compared with intermediate-/high-risk SAVR patients (2.52 [95% CI: 0.26-4.13]). SAVR patients had significantly longer median intensive care unit and overall length of stay and higher blood transfusion requirements but similar rates of stroke and pacemaker implantation. CONCLUSIONS: TAVR was associated with excellent in-hospital outcomes and better survival compared with intermediate-/high-risk SAVR in patients with CRT-AS. While SAVR still has a role in low-risk patients or those for whom TAVR is unsuitable for technical or anatomical reasons, TAVR is emerging as the standard of care for intermediate-/high-risk CRT-AS patients.
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Yazdchi et al. (2021) conducted a cohort in Severe aortic stenosis with previous chest-directed radiation therapy (n=186). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Operative mortality (in-house or within 30 days) (p=0.41). Transcatheter aortic valve replacement was associated with similar overall operative mortality but better mid-term survival compared to intermediate- or high-risk surgical aortic valve replacement in patients with previous chest-directed radiation therapy.
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