The rise of new technologies for aortic valve stenosis: A comparison of sutureless and transcatheter aortic valve implantation

Augusto D'Onofrio, Stefano Salizzoni, Antonino S. Rubino, Laura Besola, Claudia Filippini, Ottavio Alfieri, Antonio Colombo, Marco Agrifoglio, Theodor Fischlein, Filippo Rapetto, Giuseppe Tarantini, Magnus Dalèn, Davide Gabbieri, Bart Meuris, Carlo Savini, Giuseppe Gatti, Marco Luigi Aiello, Fausto Biancari, Ugolino Livi, Pier Luigi StefànoMauro Cassese, Bruno Borrello, Mauro Rinaldi, Carmelo Mignosa, Gino Gerosa, Italian Transcatheter Balloon-Expandable Registry and the Sutureless Aortic Valve Implantation Research Groups

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)99-109.e2
JournalJournal of Thoracic and Cardiovascular Surgery
Volume152
Issue number1
DOIs
Publication statusPublished - Jul 2016

Keywords

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis
  • Female
  • Heart Valve Prosthesis Implantation
  • Humans
  • Male
  • Transcatheter Aortic Valve Replacement
  • Comparative Study
  • Journal Article

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