title: A comparison of transcatheter aortic valve implantation and surgical aortic valve replacement in 1,141 patients with severe symptomatic aortic stenosis and less than high risk.
abstract: OBJECTIVE
  To assess outcomes for patients undergoing transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement but with less than high risk.
  
  
  BACKGROUND
  While there is abundant data for high risk patients there is insufficient data for reduced risk.
  
  
  METHODS
  Patients undergoing TAVI or SAVR between 2007 and 2012 in Karlsruhe were considered. They were assessed by cardiac computed tomography, transoesophageal echocardiogram, and logistic EuroSCORE I (ES) and groups compared using Propensity Score Matching.
  
  
  RESULTS
  The mean ES was 10.1±2.8 in the TAVI group (n = 419) and 5.7 ± 3.2 in the SAVR group (n = 722; P < 0.0001). Mean survival probability over 3 years was higher in patients undergoing surgery (P < 0.0001). A total of 432 patients were considered for the matched-pairs analysis based on propensity scores (216 in each group). Major vascular complications (10.6% vs. 0.0%; P < 0.0001), new pacemaker implantation (13.9% vs. 4.6%; P < 0.001) and moderate aortic insufficiency (3.2% vs. 0.5%; P = 0.03) were more frequent in patients undergoing TAVI. Major (20.8% vs. 4.2%; P < 0.0001) and life-threatening (14.5% vs. 2.3%; P < 0.0001) bleeding complications were more frequent in those undergoing surgery. Survival probability over 3 years in the propensity matched cohort was comparable between both groups (P = 0.16).
  
  
  CONCLUSIONS
  In this large, single center, real world dataset there was no difference in mortality between patients undergoing TAVI or SAVR during a 3-year follow-up but there was a TAVI related increase in major vascular complications, new pacemaker implantation and aortic insufficiency and a SAVR related increased bleeding risk.
authors: 1Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Freiburg, Germany.
authors: Gerhard
authors: G
authors: Schymik
authors: Clinic for Cardiac Surgery, Karlsruhe, Germany.
authors: Martin
authors: M
authors: Heimeshoff
authors: Institut Für Pharmakologie und Präventive Medizin, Mahlow, Germany.
authors: Peter
authors: P
authors: Bramlage
authors: 1Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Freiburg, Germany.
authors: Tanja
authors: T
authors: Herbinger
authors: Medical Clinic III-Department of Cardiology, Vincentius Hospital, Karlsruhe, Germany.
authors: Alexander
authors: A
authors: Würth
authors: Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors: Lothar
authors: L
authors: Pilz
authors: Munich Graduate School of Economics LMU, Munich, Germany.
authors: Jan S
authors: JS
authors: Schymik
authors: 1Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Freiburg, Germany.
authors: Rainer
authors: R
authors: Wondraschek
authors: Medical Clinic I-Department of Cardiology, Mannheim University, Mannheim, Germany.
authors: Tim
authors: T
authors: Süselbeck
authors: Clinic for Cardiac Surgery, Karlsruhe, Germany.
authors: Jan
authors: J
authors: Gerhardus
authors: 1Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Freiburg, Germany.
authors: Armin
authors: A
authors: Luik
authors: Medical Clinic III-Department of Cardiology, Vincentius Hospital, Karlsruhe, Germany.
authors: Bernd-Dieter
authors: BD
authors: Gonska
authors: 1Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Freiburg, Germany.
authors: Panagiotis
authors: P
authors: Tzamalis
authors: Clinic for Cardiac Surgery, Karlsruhe, Germany.
authors: Herbert
authors: H
authors: Posival
authors: 1Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Freiburg, Germany.
authors: Claus
authors: C
authors: Schmitt
authors: Clinic for Cardiac Surgery, Karlsruhe, Germany.
authors: Holger
authors: H
authors: Schröfel
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality; D015331:Cohort Studies; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
keywords: EuroSCORE; TAVI; age; mortality; risk factors; surgery