title: Rapid-deployment or transcatheter aortic valves in intermediate-risk patients?
abstract: Background Transcatheter aortic valve implantation and rapid-deployment aortic valve replacement represent two emerging therapies for patients with intermediate surgical risk and severe aortic stenosis. However, head-to-head comparisons between such novel therapies are lacking. Methods Severe aortic stenosis patients with intermediate surgical risk treated with rapid-deployment valve replacement at our institution were identified and compared with a propensity-matched population of patients who underwent transcatheter aortic valve replacement. Postoperative echocardiographic findings, in-hospital and midterm clinical outcomes were compared. Results We identified 60 patients who received transcatheter ( n = 30) or rapid-deployment ( n = 30) valve replacement. On postoperative echocardiography, freedom from paravalvular regurgitation was higher in the rapid-deployment valve group ( p < 0.001), while postoperative mean transprosthetic gradient was lower in the transcatheter valve group ( p = 0.03). Permanent pacemaker implantation was required more frequently in transcatheter valve patients ( p = 0.01). Postoperative atrial fibrillation was more common in the rapid-deployment valve group ( p = 0.03). Hospital mortality was similarly low in both groups ( p = 0.33). At midterm follow-up, mortality was comparable ( p = 0.42) but the rapid-deployment valve group still had a lower degree of paravalvular regurgitation. Conclusions Transcatheter and rapid-deployment valve replacement are promising treatment options for patients with intermediate surgical risk. These two techniques are associated with specific patterns of prosthesis function and postoperative complications. Further evaluation of the clinical impact of these therapies in this patient population is needed.
authors.affiliation: 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Bruno
authors.affiliation: 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Cesare
authors.affiliation: 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Marialisa
authors.initials: M
authors.lastname: Nesta
authors.affiliation: 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Cammertoni
authors.affiliation: 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mazza
authors.affiliation: 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Lazzaro
authors.initials: L
authors.lastname: Paraggio
authors.affiliation: 2 Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
authors.forename: Raphael
authors.initials: R
authors.lastname: Rosenhek
authors.affiliation: 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.affiliation: 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.affiliation: 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.affiliation: 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Massetti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
keywords: Aortic stenosis; Aortic valve; Heart valve prosthesis implantation; Minimally invasive surgical procedures; Sutureless surgical procedures; Transcatheter aortic valve replacement