Transcatheter aortic valve implantation yielded comparable 3-year survival to surgical replacement in less-than-high-risk patients (P=0.16), with higher vascular complications but lower bleeding.
Cohort (n=1,141)
No
Does transcatheter aortic valve implantation improve survival compared to surgical aortic valve replacement in patients with severe symptomatic aortic stenosis and less than high risk?
In patients with severe symptomatic aortic stenosis at less than high surgical risk, TAVI and SAVR demonstrated comparable 3-year survival but differing complication profiles.
p-value: p=0.16
OBJECTIVES: To assess outcomes for patients undergoing transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement but with less than high risk. BACKGROUND: While there is abundant data for high risk patients there is insufficient data for reduced risk. METHODS: Patients undergoing TAVI or SAVR between 2007 and 2012 in Karlsruhe were considered. They were assessed by cardiac computed tomography, transoesophageal echocardiogram, and logistic EuroSCORE I (ES) and groups compared using Propensity Score Matching. RESULTS: The mean ES was 10.1±2.8 in the TAVI group (n = 419) and 5.7 ± 3.2 in the SAVR group (n = 722; P < 0.0001). Mean survival probability over 3 years was higher in patients undergoing surgery (P < 0.0001). A total of 432 patients were considered for the matched-pairs analysis based on propensity scores (216 in each group). Major vascular complications (10.6% vs. 0.0%; P < 0.0001), new pacemaker implantation (13.9% vs. 4.6%; P < 0.001) and moderate aortic insufficiency (3.2% vs. 0.5%; P = 0.03) were more frequent in patients undergoing TAVI. Major (20.8% vs. 4.2%; P < 0.0001) and life-threatening (14.5% vs. 2.3%; P < 0.0001) bleeding complications were more frequent in those undergoing surgery. Survival probability over 3 years in the propensity matched cohort was comparable between both groups (P = 0.16). CONCLUSIONS: In this large, single center, real world dataset there was no difference in mortality between patients undergoing TAVI or SAVR during a 3-year follow-up but there was a TAVI related increase in major vascular complications, new pacemaker implantation and aortic insufficiency and a SAVR related increased bleeding risk.
Schymik et al. (Fri,) conducted a cohort in Severe symptomatic aortic stenosis and less than high risk (n=1,141). Transcatheter aortic valve implantation (TAVI) vs. Surgical aortic valve replacement (SAVR) was evaluated on Survival probability over 3 years (p=0.16). Transcatheter aortic valve implantation yielded comparable 3-year survival to surgical replacement in less-than-high-risk patients (P=0.16), with higher vascular complications but lower bleeding.