title: Transcatheter versus Surgical Aortic Valve Replacement in High-risk Patients: A propensity-score matched analysis.
abstract: BACKGROUND
  There is limited data from Australia and New Zealand comparing transcatheter aortic valve implantation (TAVI) with conventional surgical aortic valve replacement (sAVR).
  
  
  METHODS
  Between 2009 and 2015, 64 patients underwent TAVI and 669 underwent sAVR at a single centre. Patients' peri-operative details were analysed and compared between groups. Propensity-score matching was performed for risk adjustment.
  
  
  RESULTS
  Patients receiving TAVI were older (mean age in years TAVI: 83.9±4.6 vs. sAVR: 71±9.9, P<0.001), and were more likely to be female (TAVI: 67%, 43/64, vs. sAVR: 32%, 217/669, P <0.001). Unadjusted 30-day mortality was comparable between groups (2/64, 3% vs. 22/669, 3%, P >0.99). The matched analysis revealed comparable 30-day mortality (TAVI: 2/44, 5% vs. sAVR: 2/44, 5%, P > 0.99). New atrial arrhythmia occurred more frequently within the sAVR cohort (TAVI: 1/44, 2% vs. sAVR 18/44, 41%, P <0.001). Complete heart block requiring permanent pacemaker was more frequent amongst the TAVI cohort (TAVI: 10/44, 23% vs. sAVR 2/44, 5%, P=0.039). At two years, survival was comparable between groups (TAVI: 74±1.7 vs. sAVR: 80±0.1%, P=0.65).
  
  
  CONCLUSIONS
  This single centre experience suggests that TAVI is a valuable treatment option for high-risk surgical patients with comparable survival.
authors.affiliation: St Vincent's Hospital, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia.
authors.forename: India
authors.initials: I
authors.lastname: Zweng
authors.affiliation: St Vincent's Hospital, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia.
authors.forename: William Y
authors.initials: WY
authors.lastname: Shi
authors.affiliation: St Vincent's Hospital, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia.
authors.forename: Sonny
authors.initials: S
authors.lastname: Palmer
authors.affiliation: St Vincent's Hospital, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: MacIsaac
authors.affiliation: St Vincent's Hospital, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Whitbourn
authors.affiliation: St Vincent's Hospital, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Davis
authors.affiliation: St Vincent's Hospital, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia. Electronic address: andrew.newcomb@svha.org.au.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Newcomb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012307:Risk Factors; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement
keywords: Aortic stenosis; Aortic valve replacement; Cardiac surgery; Elderly; High-risk; Transcatheter aortic valve insertion