title: Conventional versus Transapical Aortic Valve Replacement: Is It Time for Shift in Indications?
abstract: BackgroundThe incidence of degenerative aortic valve diseases has increased along with the life expectancy of our population. Although conventional aortic valve replacement (AVR) is the gold standard for symptomatic aortic stenosis, transcatheter procedures have proven to be a valid therapeutic option in high-risk patients. The aim of this study was to compare these procedures in a high-risk cohort.MethodsWe retrospectively analyzed all symptomatic (dyspnea or angina) high-risk patients (logistic EuroSCORE ≥ 15%) fulfilling the transcatheter aortic valve implantation (TAVI) indications. Most of the AVR patients (n= 180) were operated on before the implementation of TAVI. All TAVI procedures (n= 127) were performed transapically (TA). After matching for age, logistic EuroSCORE, and left ventricular ejection fraction, 82 pairs of patients were evaluated.ResultsWhen comparing AVR with TA-TAVI, there was no difference between groups in survival after 1 year (Kaplan-Meier analysis, 81.1% [95% CI: 72.5-89.7%] vs. 75.8% [95% CI: 66.2-75.9%], Log tankp= 0.660) and the complication rates (nfor AVR vs. TA-TAVI: stroke, 2 vs. 0,p= 0.580; acute renal insufficiency, 8 vs. 12,p= 0.340; atrial fibrillation, 24 vs. 26,p= 0.813; pacemaker implantation, 4 vs. 4,p> 0.999). In addition, quality of life did not differ between groups. Patients in the TA-TAVI group had lower mean valvular gradients postoperatively compared with the AVR group (14.6 ± 6.6 vs. 10.2 ± 4.9 mm Hg,p< 0.001).ConclusionFor high-risk patients, the TAVI procedure is comparable with conventional AVR, but is not advantageous. These results do not support the expansion of TAVI to low- or intermediate-risk patients.
authors: Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors: Hardy
authors: H
authors: Baumbach
authors: Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors: Samir
authors: S
authors: Ahad
authors: Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors: Christian
authors: C
authors: Rustenbach
authors: Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors: Stephan
authors: S
authors: Hill
authors: Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors: Tim
authors: T
authors: Schäufele
authors: Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors: Kristina
authors: K
authors: Wachter
authors: Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors: Ulrich Friedrich Wilhelm
authors: UF
authors: Franke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005858:Germany; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D016277:Ventricular Function, Left