title: Transcatheter vs. surgical aortic valve replacement:  a retrospective analysis assessing clinical effectiveness and safety.
abstract: OBJECTIVE
  To compare, in terms of clinical effectiveness and safety, patients who underwent transcatheter aortic valve implantation (TAVI) with those who underwent surgical aortic valve replacement (S-AVR) for the treatment of severe aortic stenosis during the same period.
  
  
  METHODS
  One hundred and eighty-seven consecutive patients were included: 81 with S-AVR and 106 with TAVI. Primary and secondary outcomes were reported in accordance with published reporting guidelines for valve surgery. A propensity matching model was computed in the attempt to reduce confounding effects of covariates.
  
  
  RESULTS
  Thirty-day mortality and morbidity, as well as follow-up events, did not differ between the two therapeutic options, except for ICU stay, in favor of TAVI, and occurrence of pleural effusions, in favor of S-AVR. TAVI accomplished significant mean aortic gradient reduction (better than S-AVR in the immediate postoperative and at least comparable at follow-up) and improvement in valve area and functional class (always higher than S-AVR). Although for the first year, survival was at least comparable between TAVI and S-AVR (both whole and matched groups); at later times, TAVI all-cause and noncardiac mortality was higher in the whole sample, as expected from age and comorbidities of TAVI patients. At later follow-up, in the matched subsamples, 1-year mortality rates were replicated, with a significantly higher incidence of cardiac deaths in S-AVR patients.
  
  
  CONCLUSIONS
  TAVI morbidity and mortality registered in this series are lower than those estimated for conventional surgery in high-risk patients and compare to those associated with S-AVR in good surgical candidates.
authors.affiliation: Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors.forename: Melissa
authors.initials: M
authors.lastname: Fusari
authors.forename: Veronica
authors.initials: V
authors.lastname: Bona
authors.forename: Manuela
authors.initials: M
authors.lastname: Muratori
authors.forename: Luca
authors.initials: L
authors.lastname: Salvi
authors.forename: Stefano
authors.initials: S
authors.lastname: Salis
authors.forename: Gloria
authors.initials: G
authors.lastname: Tamborini
authors.forename: Paolo
authors.initials: P
authors.lastname: Biglioli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007558:Italy; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome