title: Propensity score matched comparison of transcatheter aortic valve implantation versus conventional surgery in intermediate and low risk aortic stenosis patients: A hint of real-world.
abstract: BACKGROUND
  Recently, the use of transcatheter aortic valve implantation (TAVI) in inter-mediate-low risk patients has been evaluated in the PARTNER II randomized trial. However, in the last years, this therapy has been employed in this scenario with underreported results, as compared to surgical aortic valve replacement (SAVR).
  
  
  METHODS
  We enrolled 362 consecutive patients with severe symptomatic aortic stenosis and intermediate-low surgical risk (logEuroSCORE < 20%), treated in our center with TAVI (103 patients) or single SAVR (259 patients) between 2009 and 2014. Patients were matched according to age, gender, logEuroSCORE, and use of bioprosthesis.
  
  
  RESULTS
  Mean age of the patients was 73 ± 10.4 years, and 40.3% were women. LogEuroSCORE and Society Thoracic Surgeons score were 7.0 ± 4.4% and 4.2 ± 2.5%, respectively, with mean left ventricular ejection fraction of 52 ± 9%. There were no differences regarding other comorbidities. The length-of-hospitalization was 11 ± 5 days after TAVI vs. 17 ± 9 days after SAVR (p = 0.003). After matched comparison, no differences in terms of in-hospital mortality (5.7% after TAVI vs. 2.9% after SAVR, p = 0.687) and 1-year mortality (11.4% vs. 7.1%, p = 0.381) were found. The combined endpoint of stroke and mortality at 1-year was also similar between both groups (15.7% in TAVI patients vs. 14.4% after SAVR, p = 0.136). Multivariate analysis determined that aortic regurgitation (AR) was an independent predictor of mortality (OR = 3.623, 95% CI: 1.267-10.358, p = 0.016). Although the rate of AR was higher after TAVI, none of the patients treated with the newest generation devices (10.7%) presented more than a mild degree of AR.
  
  
  CONCLUSIONS
  TAVI is feasible and shows comparable results to surgery in terms of early, 1-year mortality, as well as cerebrovascular events in patients with severe aortic stenosis and intermediate-low operative risk. Better transvalvular gradients, yet higher rates of AR were found, however, newer devices presented comparable rate of AR.
authors.forename: Javier
authors.initials: J
authors.lastname: Castrodeza
authors.affiliation: Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain. ijamat@gmail.com.
authors.forename: Ignacio J
authors.initials: IJ
authors.lastname: Amat-Santos
authors.forename: Myriam
authors.initials: M
authors.lastname: Blanco
authors.forename: Carlos
authors.initials: C
authors.lastname: Cortes
authors.forename: Javier
authors.initials: J
authors.lastname: Tobar
authors.forename: Irene
authors.initials: I
authors.lastname: Martin-Morquecho
authors.forename: Javier
authors.initials: J
authors.lastname: López
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Stefano
authors.forename: Paol
authors.initials: P
authors.lastname: Rojas
authors.forename: Luis H
authors.initials: LH
authors.lastname: Varela-Falcon
authors.forename: Itziar
authors.initials: I
authors.lastname: Gomez
authors.forename: Jose A
authors.initials: JA
authors.lastname: San Roman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome
keywords: SAVR; TAVI; aortic stenosis; cardiac risk; propensity score