Key result
The introduction of a transcatheter aortic valve implantation program was associated with a trend toward improved 30-day survival for surgical aortic valve replacement (98.8% vs 95.8%, p=0.09) and eliminated female gender as a significant mortality risk factor.
Why the study?
Does the availability of TAVI improve the risk profile and 30-day survival of patients undergoing surgical aortic valve replacement, particularly for women?
Cohort (n=357)
No
Does the availability of TAVI improve the risk profile and 30-day survival of patients undergoing surgical aortic valve replacement, particularly for women?
The introduction of TAVI has shifted high-risk elderly patients, particularly women, away from surgical aortic valve replacement, resulting in lower surgical risk profiles and eliminating female sex as a significant risk factor for SAVR mortality.
OBJECTIVES: In 2009, a transcatheter valve intervention program was introduced at our centre. The aim of this single-centre retrospective study was to evaluate gender-specific risk profiles and outcome of patients undergoing surgical aortic valve replacement before and after 2009. METHODS: We assessed the preoperative logistic EuroSCORE and age, gender and 30-day-survival of 357 patients diagnosed with symptomatic severe aortic stenosis that underwent primary isolated surgical aortic valve replacement in 2007-2008 (group I, n = 191, 47% female) and 2010-2011 (group II, n = 166, 40% female). Survival follow up data was 100% complete. RESULTS: Women in group II were significantly younger (71.6 ± 9.0 years; p = 0.004) and showed significantly lower risk profiles (logistic EuroSCORE: 9.6 ± 9.9%; p = 0.04) than women in group I (age: 75.6 ± 8.5 years, logistic EuroSCORE: 13.9 ± 15.9). Men's age and risk profiles remained similar in both groups. Observed survival at 30 days was 98.8% in group II and 95.8% in group I which represented a statistical trend (p = 0.09). Female survival in group I was 92.2% and significantly worse as compared to 99% male survival in group I (p = 0.03). This significant difference in gender ratio of mortality was not detected in group II (female survival 97%, male survival 100%; p = 0.2). Being female was a significant risk factor in group I (odds ratio; 8.4; p = 0.03) but not in group II any longer (odds ratio: 1.0; p = 0.2). CONCLUSIONS: The possibility of transcatheter aortic valve replacement for therapy of aortic stenosis has led to a lower risk and improved outcome of surgical aortic valve replacement especially for women.
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Heinze et al. (2015) conducted a cohort in Symptomatic severe aortic stenosis (n=357). SAVR after TAVI program introduction vs. SAVR before TAVI program introduction was evaluated on 30-day survival (p=0.09). The introduction of a transcatheter aortic valve implantation program was associated with a trend toward improved 30-day survival for surgical aortic valve replacement (98.8% vs 95.8%, p=0.09) and eliminated female gender as a significant mortality risk factor.
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