August 18, 2019Catheterization and Cardiovascular Interventions
Factors influencing the choice between transcatheter and surgical treatment of severe aortic stenosis in patients younger than 80 years: Results from the OBSERVANT study
Key result
Prior cardiac surgery is linked to ~25-fold higher odds of choosing TAVI over SAVR.
- OR 24.73
- 95% CI 12.71-48.10
- P<0.001
- n=4,801
Why the study?
Patients younger than 80 years undergoing TAVI are less studied and the factors guiding Heart Team decisions between TAVI and SAVR in this population are not well defined.
What factors influence the choice between TAVI and SAVR in patients under 80 years with severe aortic stenosis, and what are their outcomes?
Population
4,801 patients under 80 years with symptomatic severe AS in 93 Italian hospitals
Comparison
Transfemoral TAVI vs surgical aortic valve replacement (SAVR)
Design
Multicenter observational prospective cohort study
Follow-up
Up to 5 years
Authors
Discussion
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Member takes
Implication
Informs TAVI versus SAVR decisions in younger severe AS; observational data leave open whether drivers reflect optimal allocation.
Study Design
Type
Cohort (n=4,801)
Multicenter
Yes
Structured PICO
What factors influence the choice between TAVI and SAVR in patients under 80 years with severe aortic stenosis, and what are their outcomes?
P
Population
4,801 patients under 80 years of age with symptomatic severe aortic stenosis undergoing SAVR or TAVI across 93 Italian hospitals, followed for up to 5 years.
E
Exposure
Transfemoral transcatheter aortic valve implantation (TAVI)
C
Comparator
Surgical aortic valve replacement (SAVR)
O
Outcome
Variables guiding Heart Team decision toward TAVI and clinical outcomes up to 5 years of follow-uphard clinical
Main Result
Odds Ratio: 24.73 (95% CI 12.71–48.1)
p-value: p=<0.001
In patients under 80 with severe aortic stenosis, TAVI is selected over SAVR primarily due to high-risk anatomical and clinical factors, resulting in a cohort with higher baseline risk and worse long-term outcomes.
Cite This Study
Tarantini et al. (2019) conducted a cohort in symptomatic severe aortic stenosis (n=4,801). TAVI vs. SAVR was evaluated on Decision to perform TAVI over SAVR (predicted by previous cardiac surgery) (OR 24.73, 95% CI 12.71-48.10, p=<0.001). In patients under 80 with severe aortic stenosis, the decision to perform TAVI over SAVR was strongly driven by previous cardiac surgery (OR 24.73; 95% CI 12.71-48.10; P<0.001) and porcelain aorta.