title: Clinical outcomes in patients after surgical and transcatheter aortic valve replacement.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) and minimally invasive aortic valve replacement (minithoracotomy and ministernotomy) have become a valuable alternative to conventional surgical treatment of severe aortic stenosis (AS) in high-risk patients.
  
  
  OBJECTIVE
  The aim of the study was to evaluate long-term results and complications in patients with symptomatic AS treated with TAVI, surgical aortic valve replacement (SAVR), minithoracotomy, or ministernotomy.
  
  
  METHODS
  A total of 173 patients with symptomatic AS were enrolled to the study between the years 2011 and 2013. Propensity scores were calculated for TAVI and each surgical method separately. Differences in clinical outcomes between patients treated with TAVI and those treated with surgical methods were adjusted for propensity scores using a logistic regression analysis and presented as adjusted odds ratios with 95% confidence intrervals.
  
  
  RESULTS
  A median follow-up was 583.5 days (interquartile range, 298-736 days). Before aortic valve replacement (AVR), no significant differences in ejection fraction (EF) were observed between the groups. At 1 week after AVR, mean EF values were significantly higher in patients after TAVI in comparison with the other groups (TAVI, 50.2% ±13.1%; minithoracotomy, 44.1% ±13.4%; ministernotomy, 37.8% ±12.8%; SAVR, 40.3% ±12.5%; P = 0.001). There were no differences in the longest available follow-up mortality between the analyzed groups (P = 0.8). To our best knowledge, this is the first study comparing minithoracotomy, ministernotomy, and SAVR with TAVI in terms of long-term outcomes such as the longest available follow-up mortality, left ventricular (LV) function, complications after the procedure, and conduction disturbances and arrhythmias after the procedure.
  
  
  CONCLUSIONS
  Patients undergoing TAVI show more beneficial long-term outcomes in comparison with patients undergoing minithoracotomy, ministernotomy, and SAVR and do not differ in terms of the longest available follow-up mortality. TAVI seems to have a more favorable effect on LV function and an increase in EF in comparison with the surgical methods.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Tokarek
authors.forename: Robert
authors.initials: R
authors.lastname: Sobczyński
authors.forename: Artur
authors.initials: A
authors.lastname: Dziewierz
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Siudak
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zasada
authors.forename: Danuta
authors.initials: D
authors.lastname: Sorysz
authors.forename: Roman
authors.initials: R
authors.lastname: Pfitzner
authors.forename: Jerzy
authors.initials: J
authors.lastname: Sadowski
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Dębski
authors.forename: Ewa
authors.initials: E
authors.lastname: Dziewięcka
authors.forename: Krystian
authors.initials: K
authors.lastname: Gruszka
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome