Key result
Early TAVI was associated with a significantly higher risk of all-cause mortality at 3 years compared to SAVR (HR 9.98; 95% CI 2.71-36.67; P<0.001).
Why the study?
Asian countries have been slower to adopt TAVI than Western countries, prompting an evaluation of early single-center TAVI outcomes and newly designed Chinese valves.
Does transcatheter aortic valve implantation improve outcomes compared to surgical aortic valve replacement in older Asian patients?
Cohort (n=284)
No
Does transcatheter aortic valve implantation improve outcomes compared to surgical aortic valve replacement in older Asian patients?
Early experience with TAVI at a single Asian center demonstrated higher 3-year mortality compared to SAVR, highlighting challenges during the initial adoption phase.
Answers are grounded in this paper and cite their sources.
Early TAVI linked to higher mortality and PPI versus SAVR in this Asian series; leaves open optimal valve choice and applicability to contemporary lower-risk patients.
BACKGROUND: Transcatheter aortic valve implantation (TAVI) continues to expand as an optimal treatment in Western countries; however, Asian countries have been slower to adopt this procedure. This research aimed to explore the outcomes and status of early TAVI performed at a single center in Asia, and provide comparative outcomes of the newly designed Chinese valves. METHODS: We enrolled 175 consecutive patients who successfully underwent TAVI from September 2012 to January 2018 at Fuwai Hospital (Beijing, China). After a preliminary assessment of age, we included 109 older patients (≥69 years) who underwent surgical aortic valve replacement (SAVR) during the same period. The primary endpoint was all-cause mortality. The inverse probability of treatment weighting (IPTW) was used to reduce potential bias. Cox regression was used to identify the risk factors of a poor prognosis. RESULTS: 1.6%, HR: 9.98, 95% CI: 2.71 to 36.67, IPTW-adjusted P<0.001) at 3 years than the SAVR cohort. In the multivariable Cox regression analysis based on the entire sample, liver disease was associated with all-cause mortality (HR: 5.080, 95% CI: 1.067 to 24.174, P=0.041). A smoking history was associated with an increased risk of postoperative heart failure (HF) (HR: 4.902, 95% CI: 1.265 to 18.999, P=0.022). Additionally, age (HR: 1.141, 95% CI: 1.010 to 1.288, P=0.034) and diabetes (HR: 7.301, 95% CI: 2.414 to 22.079, P<0.001) were identified as predictors of postoperative stroke. In the new valve subgroups, the 1-year composite endpoints were 38.2% (Venus A), 35.3% (TaurusOne), 34% (J-Valve), and 28% (VitaFlow) (P=0.857). CONCLUSIONS: Not all TAVI procedures had satisfactory outcomes compared with SAVR when initiated. At first, our center faced some challenges in delivering TAVI, and this is probably one of the reasons why the use of TAVI has developed slowly in Asia. Further investigations are needed to explore the underlying factors precluding the rapid expansion of TAVI in Asia.
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Liang et al. (2021) conducted a cohort in Aortic valve disease (n=284). Transcatheter aortic valve implantation (TAVI) vs. Surgical aortic valve replacement (SAVR) was evaluated on All-cause mortality (HR 9.98, 95% CI 2.71-36.67, p=<0.001). Early TAVI was associated with a significantly higher risk of all-cause mortality at 3 years compared to SAVR (HR 9.98; 95% CI 2.71-36.67; P<0.001).
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