Impact of treatment choice on the outcome of patients proposed for transcatheter aortic valve implantation.
OBJECTIVE
Transcatheter aortic valve implantation (TAVI) is a new option for patients with severe aortic stenosis at high surgical risk. We compared the clinical outcome of patients referred for TAVI and subsequently treated with TAVI, surgical aortic valve replacement (SAVR), balloon aortic valvuloplasty (BAV), or medical management (MM).


RESULTS
All consecutive patients (n=166, EuroSCORE 24.9 ± 13.9%) referred for TAVI to our two centres were enrolled in a prospective registry and were assigned to SAVR (n=21), TAVI with the CoreValve prosthesis (n=75), BAV (n=20), or MM (n=50) by a multi-specialty team. The primary endpoint was 6-month cardiac mortality. Patients undergoing BAV had a significantly higher EuroSCORE (33.6 ± 15.9%; p=0.01). Median follow-up time was nine months (interquartile range 4.5-12.4 months). Six-month freedom from cardiac death was 81.0 ± 8.6%, 92.0 ± 3.1%, 72.9 ± 10.5%, and 72.7 ± 6.5% for SAVR, TAVI, BAV, and MM groups, respectively. Freedom from major cardiac and cerebrovascular events was 76.2 ± 9.3%, 83.9 ± 4.3%, 72.9 ± 10.5%, and 65.6 ± 6.8% for SAVR, TAVI, BAV, and MM groups, respectively.


CONCLUSIONS
With respect to medical management and BAV, TAVI was associated with lower cardiac mortality at six months. Clinical outcome after TAVI was similar to that of less sick patients undergoing SAVR.
Cardiac Catheterisation Laboratory, Cardiothoracic Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. marcodecarlo@gmail.com
Marco
M
De Carlo
Cristina
C
Giannini
Federica
F
Ettori
Claudia
C
Fiorina
Fabio
F
Guarracino
Salvatore
S
Curello
Giovanni
G
Scioti
Gaetano
G
Minzioni
Giuliano
G
Chizzola
Diego
D
Matteo
A Sonia
AS
Petronio
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D002404:Catheterization; D015331:Cohort Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome