Unit:
Speciality Endovascular TechniquesLibrary of the School of Health Sciences
Author:
Roussakis Antonios
Supervisors info:
Γεώργιος Γερουλάκος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Ιωάννης Κακίσης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αχιλλέας Χατζηϊωάννου, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Χειρουργική Αντικατάσταση έναντι Διακαθετηριακής Εμφύτευσης Αορτικής Βαλβίδας – Αναδρομική Συγκριτική Μελέτη
Translated title:
Surgical Replacement versus Transcatheter Aortic Valve Implantation - Retrospective Comparative Study
Summary:
Aim
Aortic valve disease is the 3rd more frequent cardiovascular disease and severe aortic valve stenosis is the most frequent valvular pathology. Until recently, the surgical replacement of the native aortic valve with a prosthetic mechanical or tissue valve (Surgical Aortic Valve Replacement - SAVR), was the only reliable and well standardized choice of treatment. Over the last decade the Transcatheter Aortic Valve Implantation (TAVI) emerged as less invasive and reliable alternative to SAVR. Aim of this study was to present the experience of the Interventional Cardiology Department and the 1st Cardiac Surgery Department of Onassis Cardiac Surgery Center in the two techniques (TAVI and SAVR) and to evaluate them (TAVI vs SAVR) studying comparatively perioperative parameters (including complications) and mortality rates (in-hospital, 30-day and 1-year mortality).
Materials and Methods
From 2015 until May 2019, 326 consecutive patients with severe aortic valve stenosis underwent TAVI procedure through various approaches but mainly through trans-femoral (Ν=280 [85.9%]), trans-subclavian (Ν=17 [5.2%]) or trans-apical (N=14 [4.3%]) approach. Deferent implantation devices were used, with Evolut R of Medronic being the most popular (Ν=240, [73.6%]). The surgical cohort compared with TAVI group included 341 consecutive patients who underwent isolated SAVR from the 1st Cardiac Surgery Department of Onassis Cardiac Surgery Center the period between 2016-2019. The 2 populations, 326 TAVI patients and 341 SAVR patients, were matched for age, gender and Euroscore II, creating 2 homogenized groups of 94 patients each. All patients were followed-up up to 1 year after the operation.
Results
After propensity score matching 94 patients with TAVI were matched with 94 patients with SAVR for sex, age and euroscore II with the following characteristics: mean age 77.5 (±6.6) and 76.6 (±6.5) years respectively, gender 51.1% female in both groups και and EuroSCORE II 3.31% (± 1.88) and 3.0% (±1.84) respectively.
Major bleeding (need for transfusion with >1 unit of RBC) was more frequent in the SAVR group (14.9% vs 46.8%, p<0.001 respectively in the matched cohorts) whereas the need for permanent pacemaker implantation was higher in the TAVI group (21.3% vs 1.1%, p<0.001 in the matched cohorts). These findings were similar before and after matching. Also, the presence of insufficiency of the prosthetic valve postoperatively was significantly less frequent in the SAVR group before and after matching.
In hospital death, death rates at first month and at one year were similar for SAVR and TAVI group, both before and after matching, and the reasons of death had similar distribution in both cohorts.
Both total in hospital (median value: TAVI 7 days (IQR 6-9) vs SAVR 6 days (IQR 6-7), p<0.001) and ICU stay (median value: TAVI 2 days (IQR 2-3) vs SAVR 1.3 days (IQR 1.3-2.0), p<0.001) were lower for the SAVR group before matching. After matching, only a tendency for less ICU stay was observed in favor of the SAVR group (p=0.082).
Conclusion
This study confirmed that TAVI is a safe and reliable treatment for patients who are of high or intermediate surgical risk and suffer from aortic valve stenosis. TAVI patients presented similar results concerning mortality when compared with SAVR patients. Real-life medicine studies with longer postoperative follow-up of TAVI patients are needed in order to reach safe conclusions concerning the exact indications of TAVI technique in comparison to the SAVR procedure which is studied much more extensively and in depth.
Main subject category:
Health Sciences
Keywords:
Aortic valve stenosis, Surgical aortic valve replacement, Transcather aortic valve implantation
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