TY - JOUR
T1 - The rise of new technologies for aortic valve stenosis
T2 - A comparison of sutureless and transcatheter aortic valve implantation
AU - D'Onofrio, Augusto
AU - Salizzoni, Stefano
AU - Rubino, Antonino S.
AU - Besola, Laura
AU - Filippini, Claudia
AU - Alfieri, Ottavio
AU - Colombo, Antonio
AU - Agrifoglio, Marco
AU - Fischlein, Theodor
AU - Rapetto, Filippo
AU - Tarantini, Giuseppe
AU - Dalèn, Magnus
AU - Gabbieri, Davide
AU - Meuris, Bart
AU - Savini, Carlo
AU - Gatti, Giuseppe
AU - Aiello, Marco Luigi
AU - Biancari, Fausto
AU - Livi, Ugolino
AU - Stefàno, Pier Luigi
AU - Cassese, Mauro
AU - Borrello, Bruno
AU - Rinaldi, Mauro
AU - Mignosa, Carmelo
AU - Gerosa, Gino
PY - 2015/5/5
Y1 - 2015/5/5
N2 - Objective: Transcatheter aortic valve implantation (TAVI) and sutureless aortic valve replacement (SU-AVR) are suitable alternatives to conventional surgery. The aim of this study is to compare early outcomes of patients undergoing TAVI and SU-AVR. Methods: Data were analyzed on patients who underwent TAVI and patients who underwent SU-AVR. Two matched cohorts (TAVI vs SU-AVR) were created using propensity scores; all analyses were repeated for transapical TAVI and transfemoral TAVI, separately. Outcomes were defined according to Valve Academic Research Consortium-2 criteria. Results: A total of 2177 patients were included in the analysis: 1885 (86.6%) treated with TAVI; 292 (13.4%) treated with SU-AVR. Mortality in unmatched TAVI and SU-AVR patients was 7.1% and 2.1%, respectively, at 30 days, and 12.9% and 4.6%, respectively, at 1 year. No differences were found in 30-day mortality in the 214 matched patient pairs (3.7% vs 2.3%; P = .4), but patients treated with TAVI showed a lower incidence of device success (85.9% vs 98.6%; P <.001) and pacemaker implantation (2.8% vs 9.4%; P = .005), and a higher incidence of any paravalvular leakage (PVL). Conclusions: SU-AVR is associated with better device success and a lower incidence of PVL, compared with TAVI. Nevertheless, patients treated with SU-AVR were more likely to receive a permanent pacemaker. SU-AVR and TAVI provide good results in patients who have severe symptomatic aortic valve stenosis. Given the multiple therapeutic options available, patients may receive the treatment that is most appropriate for their clinical and anatomical characteristics.
AB - Objective: Transcatheter aortic valve implantation (TAVI) and sutureless aortic valve replacement (SU-AVR) are suitable alternatives to conventional surgery. The aim of this study is to compare early outcomes of patients undergoing TAVI and SU-AVR. Methods: Data were analyzed on patients who underwent TAVI and patients who underwent SU-AVR. Two matched cohorts (TAVI vs SU-AVR) were created using propensity scores; all analyses were repeated for transapical TAVI and transfemoral TAVI, separately. Outcomes were defined according to Valve Academic Research Consortium-2 criteria. Results: A total of 2177 patients were included in the analysis: 1885 (86.6%) treated with TAVI; 292 (13.4%) treated with SU-AVR. Mortality in unmatched TAVI and SU-AVR patients was 7.1% and 2.1%, respectively, at 30 days, and 12.9% and 4.6%, respectively, at 1 year. No differences were found in 30-day mortality in the 214 matched patient pairs (3.7% vs 2.3%; P = .4), but patients treated with TAVI showed a lower incidence of device success (85.9% vs 98.6%; P <.001) and pacemaker implantation (2.8% vs 9.4%; P = .005), and a higher incidence of any paravalvular leakage (PVL). Conclusions: SU-AVR is associated with better device success and a lower incidence of PVL, compared with TAVI. Nevertheless, patients treated with SU-AVR were more likely to receive a permanent pacemaker. SU-AVR and TAVI provide good results in patients who have severe symptomatic aortic valve stenosis. Given the multiple therapeutic options available, patients may receive the treatment that is most appropriate for their clinical and anatomical characteristics.
KW - Aortic valve replacement
KW - Heart valve replacement
KW - Heart valve replacement sutureless
KW - Percutaneous
KW - Transapical
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U2 - 10.1016/j.jtcvs.2015.11.041
DO - 10.1016/j.jtcvs.2015.11.041
M3 - Article
AN - SCOPUS:84958259866
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
SN - 0022-5223
ER -