Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis: Results from an intermediate risk propensity-matched population of the Italian OBSERVANT study

Paola D'Errigo, Marco Barbanti, Marco Ranucci, Francesco Onorati, Remo Daniel Covello, Stefano Rosato, Corrado Tamburino, Francesco Santini, Gennaro Santoro, Fulvia Seccareccia

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Few studies have yielded information on comparative effectiveness of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) procedures in a real-world setting. The aim of this analysis is to describe procedural and post-procedural outcomes in a TAVI/SAVR intermediate risk propensity-matched population. Methods: OBSERVANT is an observational prospective multicenter cohort study, enrolling AS patients undergoing SAVR or TAVI. Propensity score method was applied to analyze procedural and post-procedural outcomes. Pairs of patients with the same probability score were matched (caliper matching). Results: The unadjusted enrolled population (N = 2108) comprises 1383 SAVR patients, 602 transarterial-TAVI patients and 123 transapical-TAVI patients. Matched population comprised a total of 266 patients (133 patients for each group). A relatively low risk population was selected (mean logistic EuroSCORE 9.4 ± 10.4% vs 8.9 ± 9.5%, SAVR vs TAVI; p = 0.650). Thirty-day mortality was 3.8% for both SAVR and TAVI (p = 1.000). The incidence of stroke (1.5% SAVR and 0.0% TAVI; p = 0.156) and myocardial infarction (0.8% SAVR and 0.8% TAVI; p = 1.000) was not statistically different between groups, whereas a higher requirement for blood transfusion was reported across the surgical cohort (49.6% vs 36.1%; p = 0.026). A higher incidence of major vascular damage (5.3% vs. 0.0%; p = 0.007) and pacemaker implantation(0.8% vs 12.0%; p = 0.001) were reported in the TAVI group. Conclusions: Patients undergoing transcatheter and surgical treatment of severe aortic stenosis are still extremely distinct populations. In the relatively low-risk propensity-matched population analyzed, despite similar procedural and 30-day mortality, SAVR was associated with a higher risk for blood transfusion, whereas TAVI showed a significantly increased rate of vascular damage, permanent AV block and residual aortic valve regurgitation.

Original languageEnglish
Pages (from-to)1945-1952
Number of pages8
JournalInternational Journal of Cardiology
Volume167
Issue number5
DOIs
Publication statusPublished - Sep 1 2013

Keywords

  • Aortic stenosis
  • Intermediate risk
  • SAVR
  • TAVI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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