title: Comparison of early clinical outcomes following transcatheter aortic valve implantation versus surgical aortic valve replacement versus optimal medical therapy in patients older than 80 years with symptomatic severe aortic stenosis.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) has become an attractive therapeutic strategy for severe aortic stenosis (AS) in elderly patients due to its minimally-invasive nature. Therefore, early results of its clinical outcomes in elderly Korean patients were evaluated.
  
  
  METHODS
  We compared early clinical outcomes of TAVI, surgical aortic valve replacement (SAVR), and optimal medical therapy (OMT) in patients aged≥80 years with symptomatic severe AS. Treatment groups were allocated as follows: TAVI (n=10), SAVR (n=14), and OMT (n=42).
  
  
  RESULTS
  Baseline clinical characteristics including predicted operative mortality were similar among the three groups. However, patients with New York Heart Association functional class III or IV symptoms and smaller aortic valve area were treated with TAVI or SAVR rather than OMT. In-hospital combined safety endpoints (all-cause mortality, major stroke, peri-procedural myocardial infarction, life-threatening bleeding, major vascular complication, and acute kidney injury) after TAVI or SAVR were significantly lower in the TAVI group than in the SAVR group (10.0% vs. 71.4%, respectively, p=0.005), along with an acceptable rate of symptom improvement and device success. During the follow-up period, the TAVI group showed the lowest rate of 3-month major adverse cardiovascular and cerebrovascular events, a composite of all-cause mortality, myocardial infarction, major stroke, and re-hospitalization (TAVI 0.0% vs. SAVR 50.0% vs. OMT 42.9%, p=0.017).
  
  
  CONCLUSIONS
  Treatment with TAVI was associated with lower event rates compared to SAVR or OMT. Therefore, TAVI may be considered as the first therapeutic strategy in selected patients aged≥80 years with symptomatic severe AS.
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
authors.forename: Eui
authors.initials: E
authors.lastname: Im
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.forename: Dong-Ho
authors.initials: DH
authors.lastname: Shin
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Byeong-Keuk
authors.initials: BK
authors.lastname: Kim
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.forename: Chi Young
authors.initials: CY
authors.lastname: Shim
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
authors.forename: Jae-Kwang
authors.initials: JK
authors.lastname: Shim
authors.forename: Young-Lan
authors.initials: YL
authors.lastname: Kwak
authors.forename: Sak
authors.initials: S
authors.lastname: Lee
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Chang
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Aortic stenosis; transcatheter aortic valve implantation; treatment outcome
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