Key result
Transapical TAVI is linked to similar 30-day mortality as AVR but worse 3-year survival.
Why the study?
Does transapical TAVI improve survival and reduce complications compared to conventional AVR in patients requiring aortic valve replacement?
Cohort (n=334)
Does transapical TAVI improve survival and reduce complications compared to conventional AVR in patients requiring aortic valve replacement?
Absolute Event Rate: 8.4% vs 10.8%
p-value: p=0.56
Conventional surgical aortic valve replacement provides superior long-term survival and fewer periprocedural complications compared to transapical TAVI in this propensity-matched cohort.
Transapical TAVI should not yet supplant AVR; leaves open whether randomized trials would confirm the observed long-term disadvantage.
INTRODUCTION: The goal of this study was to compare the short- and long-term outcomes after aortic valve (AV) surgery carried out via standard sternotomy/partial sternotomy versus transapical transcatheter AV implantation (taTAVI). PATIENTS AND METHODS: All 336 patients who underwent taTAVI between 2006 and 2010 were compared with 4533 patients who underwent conventional AV replacement (AVR) operations between 2001 and 2010. Using propensity score matching, we identified and consecutively compared 2 very similar groups of 167 patients each. The focus was on periprocedural complications and long-term survival. RESULTS: The 30-day mortality rate was 10.8% and 8.4% (P = .56) for the conventional AVR patients and the TAVI patients, respectively. The percentages of postoperative pacemaker implantations (15.0% versus 6.0%, P = .017) and cases of renal failure requiring dialysis (25.7% versus 12.6%, P = .004) were higher in the TAVI group. Kaplan-Meier curves diverged after half a year in favor of conventional surgery. The estimated 3-year survival rates were 53.5% ± 5.7% (TAVI) and 66.7% ± 0.2% (conventional AVR). CONCLUSION: Our study shows that even with all the latest successes in catheter-based AV implantation, the conventional surgical approach is still a very good treatment option with excellent long-term results, even for older, high-risk patients.
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Holzhey et al. (2012) conducted a cohort in Aortic valve disease requiring replacement (n=334). Transapical transcatheter aortic valve implantation (taTAVI) vs. Conventional aortic valve replacement (AVR) was evaluated on 30-day mortality (p=0.56). Transapical TAVI had similar 30-day mortality to conventional AVR (8.4% vs 10.8%, P=0.56) but higher rates of pacemaker implantation and renal failure, and lower 3-year survival (53.5% vs 66.7%).
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