Clinical outcomes in patients after surgical and transcatheter aortic valve replacement

INTRODUCTION Transcatheter aortic valve implantation (TAVI) and minimally invasive aortic valve replacement

(minithoracotomy and ministernotomy) have become a valuable alternative to conventional

surgical treatment of severe aortic stenosis (AS) in high-risk patients.

OBJECTIVES The aim of the study was to evaluate long-term results and complications in patients

with symptomatic AS treated with TAVI, surgical aortic valve replacement (SAVR), minithoracotomy,

or ministernotomy.

PATIENTS AND METHODS A total of 173 patients with symptomatic AS were enrolled to the study between

the years 2011 and 2013. Propensity scores were calculated for TAVI and each surgical method

separately. Differences in clinical outcomes between patients treated with TAVI and those treated with

surgical methods were adjusted for propensity scores using a logistic regression analysis and presented

as adjusted odds ratios with 95% confidence intrervals.

RESULTS A median follow-up was 583.5 days (interquartile range, 298–736 days). Before aortic valve

replacement (AVR), no significant differences in ejection fraction (EF) were observed between the groups.

At 1 week after AVR, mean EF values were significantly higher in patients after TAVI in comparison

with the other groups (TAVI, 50.2% ±13.1%; minithoracotomy, 44.1% ±13.4%; ministernotomy, 37.8%

±12.8%; SAVR, 40.3% ±12.5%; P = 0.001). There were no differences in the longest available follow-up

mortality between the analyzed groups (P = 0.8). To our best knowledge, this is the first study comparing

minithoracotomy, ministernotomy, and SAVR with TAVI in terms of long-term outcomes such as the

longest available follow-up mortality, left ventricular (LV) function, complications after the procedure,

and conduction disturbances and arrhythmias after the procedure.

CONCULSIONS Patients undergoing TAVI show more beneficial long-term outcomes in comparison with

patients undergoing minithoracotomy, ministernotomy, and SAVR and do not differ in terms of the longest

available follow-up mortality. TAVI seems to have a more favorable effect on LV function and an increase

in EF in comparison with the surgical methods.

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