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A comparison of transcatheter aortic valve implantation and surgical aortic valve replacement in 1,141 patients with severe symptomatic aortic stenosis and less than high risk
Author(s) -
Schymik Gerhard,
Heimeshoff Martin,
Bramlage Peter,
Herbinger Tanja,
Würth Alexander,
Pilz Lothar,
Schymik Jan S.,
Wondraschek Rainer,
Süselbeck Tim,
Gerhardus Jan,
Luik Armin,
Gonska BerndDieter,
Tzamalis Panagiotis,
Posival Herbert,
Schmitt Claus,
Schröfel Holger
Publication year - 2015
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25866
Subject(s) - medicine , propensity score matching , aortic valve replacement , stenosis , cardiology , euroscore , aortic valve stenosis , aortic valve , surgery , cohort , cardiac surgery
Objectives To assess outcomes for patients undergoing transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement but with less than high risk. Background While there is abundant data for high risk patients there is insufficient data for reduced risk. Methods Patients undergoing TAVI or SAVR between 2007 and 2012 in Karlsruhe were considered. They were assessed by cardiac computed tomography, transoesophageal echocardiogram, and logistic EuroSCORE I (ES) and groups compared using Propensity Score Matching. Results The mean ES was 10.1±2.8 in the TAVI group ( n = 419) and 5.7 ± 3.2 in the SAVR group ( n = 722; P < 0.0001). Mean survival probability over 3 years was higher in patients undergoing surgery ( P < 0.0001). A total of 432 patients were considered for the matched‐pairs analysis based on propensity scores (216 in each group). Major vascular complications (10.6% vs. 0.0%; P < 0.0001), new pacemaker implantation (13.9% vs. 4.6%; P < 0.001) and moderate aortic insufficiency (3.2% vs. 0.5%; P = 0.03) were more frequent in patients undergoing TAVI. Major (20.8% vs. 4.2%; P < 0.0001) and life‐threatening (14.5% vs. 2.3%; P < 0.0001) bleeding complications were more frequent in those undergoing surgery. Survival probability over 3 years in the propensity matched cohort was comparable between both groups ( P = 0.16). Conclusions In this large, single center, real world dataset there was no difference in mortality between patients undergoing TAVI or SAVR during a 3‐year follow‐up but there was a TAVI related increase in major vascular complications, new pacemaker implantation and aortic insufficiency and a SAVR related increased bleeding risk. © 2015 Wiley Periodicals, Inc.