title: Hemodynamic performance and outcome of percutaneous versus surgical stentless bioprostheses for aortic stenosis with anticipated patient-prosthesis mismatch.
abstract: OBJECTIVE
  We aimed to compare the performance and midterm survival of transcutaneous aortic valve replacement (TAVR) and surgically implanted stentless aortic valve replacement (SAVR) for severe aortic stenosis in patients anticipated to have patient-prosthesis mismatch (PPM).
  
  
  METHODS
  A retrospective analysis was performed of 86 and 49 consecutive TAVR and SAVR patients with severe aortic stenosis and calculated minimal effective orifice area larger than the best projected effective orifice area. Cox hazard analyses were used to assess the effect of TAVR versus SAVR on outcome.
  
  
  RESULTS
  The peak and mean transprosthetic gradient at discharge were lower (P < .001 for both) in the TAVR group. Mild or greater aortic regurgitation was more frequent in the TAVR group (61% vs 7%; P < .0001). At 3 months of follow-up, the mean gradient in the TAVR group was similar to that of the SAVR group but the prevalence of aortic regurgitation was still higher. The unadjusted 3-year survival rate was superior in the SAVR versus TAVR group (91.6% ± 4% vs 67.0% ± 7%; P = .01). Adjustments for both age and comorbidity resulted in loss of the difference in mortality between the 2 groups.
  
  
  CONCLUSIONS
  In patients with anticipated PPM, TAVR offers an immediate lower incidence of PPM than SAVR but a greater prevalence of aortic regurgitation. The differences in transaortic gradients became nonsignificant 3 months postoperatively. The question of whether TAVR is a suitable substitute for SAVR in patients with anticipated PPM, in particular, those who are older and sicker, warrants additional investigation.
authors.affiliation: Division of Cardiovascular Diseases, Tel Aviv Medical Center, Tel-Aviv, Israel.
authors.forename: Arie
authors.initials: A
authors.lastname: Finkelstein
authors.affiliation: Division of Cardiovascular Diseases, Tel Aviv Medical Center, Tel-Aviv, Israel.
authors.forename: Arie Lorin
authors.initials: AL
authors.lastname: Schwartz
authors.affiliation: Division of Cardiovascular Surgery, Tel Aviv Medical Center, Tel-Aviv, Israel.
authors.forename: Gideon
authors.initials: G
authors.lastname: Uretzky
authors.affiliation: Division of Cardiovascular Diseases, Tel Aviv Medical Center, Tel-Aviv, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Banai
authors.affiliation: Division of Cardiovascular Diseases, Tel Aviv Medical Center, Tel-Aviv, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.affiliation: Division of Cardiovascular Surgery, Tel Aviv Medical Center, Tel-Aviv, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Kramer
authors.affiliation: Division of Cardiovascular Diseases, Tel Aviv Medical Center, Tel-Aviv, Israel. Electronic address: topilskyyan@gmail.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Topilsky
mesh_terms: D000367:Age Factors; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D015897:Comorbidity; D015150:Echocardiography, Doppler; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D018579:Patient Selection; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome