title: Early and Midterm Outcome of Propensity-Matched Intermediate-Risk Patients Aged ≥80 Years With Aortic Stenosis Undergoing Surgical or Transcatheter Aortic Valve Replacement (from the Italian Multicenter OBSERVANT Study).
abstract: The aim of this study was to analyze procedural and postprocedural outcomes of patients aged ≥80 years treated by transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) as enrolled in the OBservational Study of Effectiveness of SAVR-TAVR procedures for severe Aortic steNosis Treatment (OBSERVANT) Study. TAVI is offered to patients with aortic stenosis judged inoperable or at high surgical risk. Nevertheless, it is common clinical practice to treat elderly (≥80 years) patients by TAVI regardless of surgical risk for traditional SAVR. OBSERVANT is a multicenter, observational, prospective cohort study that enrolled patients with symptomatic severe aortic stenosis who underwent SAVR or TAVI from December 2010 to June 2012 in 93 Italian participating hospitals. Information on demographic characteristics, health status before intervention, therapeutic approach, and intraprocedural and 30-day outcomes was collected. An administrative follow-up was set up to collect data on midterm to long-term outcomes. We reviewed baseline and procedural data of patients aged ≥80 years, looking for different early and late outcome after TAVI or SAVR. Patients treated by TAVI were sicker than SAVR because of higher rate of co-morbidities, advanced illness, frailty, and Logistic EuroSCORE. After propensity matching, early and midterm mortality were comparable between the 2 groups. However, patients treated by TAVI had higher rate of vascular complications (6.0% vs 0.5%; p <0.0001), permanent pacemaker implantation (13.4% vs 3.7%; p <0.0001), and paravalvular leak (8.9% vs 2.4%; p <0.0001). Patients who underwent SAVR had more frequent bleedings needing transfusion (63.2% vs 34.5%; p <0.0001) and acute kidney injury (9.6% vs 3.9%; p = 0.0010). In conclusion, patients aged ≥80 years treated by TAVI or SAVR had similar early and midterm mortality.
authors.affiliation: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy. Electronic address: chiara_fraccaro@hotmail.com.
authors.forename: Chiara
authors.initials: C
authors.lastname: Fraccaro
authors.affiliation: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rosato
authors.affiliation: Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Tellaroli
authors.affiliation: National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: D'Errigo
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ranucci
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.affiliation: Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Grossi
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Santoro
authors.affiliation: Division of Cardiac Surgery, IRCCS S Martino IST University Hospital, Genova, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
authors.affiliation: IRCCS San Raffaele, Milan, Italy.
authors.forename: Remo Daniel
authors.initials: RD
authors.lastname: Covello
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Fusco
authors.affiliation: National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Fulvia
authors.initials: F
authors.lastname: Seccareccia
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007558:Italy; D008297:Male; D057216:Propensity Score; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome