Midterm Outcomes Following Sutureless and Transcatheter Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis
Por:
Vilalta, V, Alperi, A, Cediel, G, Mohammadi, S, Fernandez-Nofrerias, E, Kalvrouziotis, D, Delarochelliere, R, Paradis, JM, Gonzalez-Lopera, M, Fadeuilhe, E, Carrillo, X, Altisent, OAJ, Rodriguez-Leor, O, Voisine, P, Bayes-Genis, A and Rodes-Cabau, J
Publicada:
1 nov 2021
Ahead of Print:
5 oct 2021
Resumen:
BACKGROUND: Sutureless-surgical aortic valve replacement (SU- SAVR) has been proposed as a surgical alternative for treating aortic stenosis, which facilitates a minimally invasive approach. While some studies have compared the early outcomes of SU- SAVR versus transcatheter aortic valve replacement (TAVR), most data were obtained in high-risk patients and/or limited to in-hospital outcomes. This study aimed to compare in-hospital and midterm clinical outcomes following SU-SAVR and TAVR in low-risk patients with aortic stenosis.
METHODS: A total of 806 consecutive low-risk (EuroSCORE II <4%) patients underwent TAVR or SU-SAVR between 2011 and 2020 in 2 centers. A 1:1 propensity score matching was performed and identified 171 pairs with similar characteristics that were included in the analysis. Baseline characteristics, in-hospital and follow-up events (defined according to Valve Academic Research Consortium-2) were collected.
RESULTS: Baseline characteristics were well balanced between groups, with a median EuroSCORE II of 1.9% (1.3%-2.5%) in both SU-SAVR and TAVR groups (P=0.85). There were no statistically significant differences regarding in-hospital mortality (SU-SAVR: 4.1%, TAVR: 1.8%, P=0.199) and stroke (SU- SAVR: 2.3%, TAVR: 2.9%, P=0.736), but SU- SAVR recipients exhibited higher rates of bleeding and new-onset atrial fibrillation, higher residual transvalvular gradients (P<0.001), and a lower rate of pacemaker implantation (P=0.011). After a median follow-up of 2 (1-3) years, there were no differences between groups in all-cause mortality (hazard ratio, 0.97 [95% CI, 0.52-1.82], P=0.936) and stroke (hazard ratio, 0.83 [95% CI, 0.322.15], P=0.708), but SU-SAVR was associated with a higher risk of heart failure hospitalization (hazard ratio, 5.38 [95% CI, 1.88-15.38], P=0.002).
CONCLUSIONS: In low-risk patients with aortic stenosis, TAVR was associated with improved in-hospital outcomes (except for conduction disturbances) and valve hemodynamics, compared with SU- SAVR. Although similar mortality and stroke rates were observed at 2-year follow-up, the risk of heart failure hospitalization was higher among SU-SAVR patients. These results may contribute to reinforce TAVR over SU- SAVR for the majority of such patients.
GRAPHIC ABSTRACT: A graphic abstract is available for this article.
Filiaciones:
:
Hosp Univ Germans Trias i Pujol, Badalona, Spain
GIBER Enfermedades Cardiovasc CIBERCV, Madrid, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Alperi, A:
Quebec Heart & Lung Inst, Quebec City, PQ, Canada
:
Hosp Univ Germans Trias i Pujol, Badalona, Spain
GIBER Enfermedades Cardiovasc CIBERCV, Madrid, Spain
Mohammadi, S:
Quebec Heart & Lung Inst, Quebec City, PQ, Canada
:
Hosp Univ Germans Trias i Pujol, Badalona, Spain
GIBER Enfermedades Cardiovasc CIBERCV, Madrid, Spain
Kalvrouziotis, D:
Quebec Heart & Lung Inst, Quebec City, PQ, Canada
Delarochelliere, R:
Quebec Heart & Lung Inst, Quebec City, PQ, Canada
Paradis, JM:
Quebec Heart & Lung Inst, Quebec City, PQ, Canada
Gonzalez-Lopera, M:
Hosp Univ Germans Trias i Pujol, Badalona, Spain
GIBER Enfermedades Cardiovasc CIBERCV, Madrid, Spain
:
Hosp Univ Germans Trias i Pujol, Badalona, Spain
GIBER Enfermedades Cardiovasc CIBERCV, Madrid, Spain
:
Hosp Univ Germans Trias i Pujol, Badalona, Spain
GIBER Enfermedades Cardiovasc CIBERCV, Madrid, Spain
:
Hosp Univ Germans Trias i Pujol, Badalona, Spain
GIBER Enfermedades Cardiovasc CIBERCV, Madrid, Spain
:
Hosp Univ Germans Trias i Pujol, Badalona, Spain
GIBER Enfermedades Cardiovasc CIBERCV, Madrid, Spain
Voisine, P:
Quebec Heart & Lung Inst, Quebec City, PQ, Canada
:
Hosp Univ Germans Trias i Pujol, Badalona, Spain
GIBER Enfermedades Cardiovasc CIBERCV, Madrid, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Rodes-Cabau, J:
Quebec Heart & Lung Inst, Quebec City, PQ, Canada
Hosp Clin Barcelona, Barcelona, Spain
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