title: Transcatheter vs surgical aortic valve replacement in intermediate-surgical-risk patients with aortic stenosis: a propensity score-matched case-control study.
abstract: BACKGROUND
  Limited real-world data comparing outcomes after transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in intermediate-surgical-risk patients with aortic stenosis are available.
  
  
  METHODS
  We identified 182 consecutive patients who underwent TAVR via the transfemoral (TF) route (November 2007-February 2011) and 111 moderate-to-high-risk historical case controls undergoing SAVR (August 2003-July 2008). Using propensity score matching based on clinical characteristics and surgical risk scores, we compared clinical outcomes in 111 matched patients. Valve Academic Research Consortium definitions were applied for end point adjudication.
  
  
  RESULTS
  Baseline clinical characteristics, in particular Logistic European System for Cardiac Operative Risk Evaluation (23.2 ± 15.1 vs 24.4 ± 13.4) and Society of Thoracic Surgeons score (4.6 ± 2.3 vs 4.6 ± 2.6), were well matched between groups. Transfemoral TAVR was associated with more vascular complications (33.3% vs 0.9%, P < .001). On the other hand, acute kidney injury was more frequent after SAVR (8.1% vs 26.1%, P < .001). The rates of all-cause mortality in both TF-TAVR and SAVR groups was1.8% at 30 days (P = 1.00) and 6.4% and 8.1%, respectively, at 1 year (P = .80). At 1 year, the rate of cerebrovascular events was similar in the 2 groups (4.6% vs 9.1%, P = .19).
  
  
  CONCLUSIONS
  In this real-world cohort of intermediate-surgical-risk patients with aortic stenosis, TF-TAVR and SAVR were associated with similar mortality rates during follow-up but with a different spectrum of periprocedural complications. Furthermore, the survival rate after TF-TAVR in this group of elderly patients with intermediate Society of Thoracic Surgeons score was encouraging.
authors.affiliation: Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Letizia
authors.initials: L
authors.lastname: Bertoldi
authors.forename: Andrea
authors.initials: A
authors.lastname: Giacomini
authors.forename: Joanne
authors.initials: J
authors.lastname: Shannon
authors.forename: Micaela
authors.initials: M
authors.lastname: Cioni
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ielasi
authors.forename: Filippo
authors.initials: F
authors.lastname: Figini
authors.forename: Kensuke
authors.initials: K
authors.lastname: Tagaki
authors.forename: Annalisa
authors.initials: A
authors.lastname: Franco
authors.forename: Remo Daniel
authors.initials: RD
authors.lastname: Covello
authors.forename: Antonio
authors.initials: A
authors.lastname: Grimaldi
authors.forename: Pietro
authors.initials: P
authors.lastname: Spagnolo
authors.forename: Gill Louise
authors.initials: GL
authors.lastname: Buchannan
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome