Comparison between transcatheter and surgical aortic valve replacement: a single-center experience.
OBJECTIVE
A comparison was made of the outcomes after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR) in high-risk patients.


METHODS
All patients aged > 75 years that underwent a procedure for severe aortic stenosis with or without coronary revascularization at the authors' institution were included in the study; thus, 64 patients underwent TAVI and 188 underwent AVR. Patients in the TAVI group were older (mean age 84 +/- 5 versus 80 +/- 4 years; p < 0.0001) and had a higher logistic EuroSCORE (p = 0.004).


RESULTS
Six patients (9%) died during the procedure in the TAVI group, and 23 (12%) died in the AVR group (p = 0.5). Predictors for mortality were: age (p < 0.0001), female gender (p = 0.02), and surgical valve replacement (p = 0.01). Gradients across the implanted valves at one to three months postoperatively were lower in the TAVI group (p < 0.0001). Actuarial survival at one, two and three years was 78%, 64% and 64%, respectively, for TAVI, and 83%, 78% and 75%, respectively, for AVR (p = 0.4). Age was the only predictor for late mortality (p < 0.0001).


CONCLUSIONS
TAVI patients were older and posed a higher predicted surgical risk. Procedural mortality was lower in the TAVI group, but mid-term survival was similar to that in patients undergoing surgical AVR. Age was the only predictor for late survival. These data support the referral of high-risk patients for TAVI.
Departments of Cardiothoracic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel. ssilberman@szmc.org.il
Shuli
S
Silberman
Firas
F
Abu Akr
Daniel
D
Bitran
Yaron
Y
Almagor
Jonathan
J
Balkin
Rachel
R
Tauber
Ofer
O
Merin
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D006328:Cardiac Catheterization / Q000379:methods / Q000401:mortality; D005260:Female; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006801:Humans; D007557:Israel; D053208:Kaplan-Meier Estimate; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome