1. One-year outcomes after surgical versus transcatheter aortic valve replacement with newer generation devices
- Author
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Rosato, S, Biancari, F, D'Errigo, P, Barbanti, M, Tarantini, G, Bedogni, F, Ranucci, M, Costa, G, Juvonen, T, Ussia, Gp, Marcellusi, A, Baglio, G, Cicala, Sd, Badoni, G, Seccareccia, F, Tamburino, C, On Behalf Of The Observant Ii Research Group, Appendix, I, Ruvolo, G, Nardi, P, Pisano, C, HUS Heart and Lung Center, III kirurgian klinikka, and Department of Surgery
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Lower risk ,Article ,03 medical and health sciences ,Transcatheter aortic valve implantation (TAVI) ,0302 clinical medicine ,Aortic valve replacement ,Valve replacement ,Internal medicine ,medicine ,Transcatheter aortic valve replacement (TAVR) ,aortic valve replacement ,030212 general & internal medicine ,Adverse effect ,Prospective cohort study ,Stroke ,METAANALYSIS ,transcatheter aortic valve replacement (TAVR) ,transcatheter aortic valve implantation (TAVI) ,business.industry ,General Medicine ,3126 Surgery, anesthesiology, intensive care, radiology ,medicine.disease ,Stenosis ,Settore MED/23 ,Heart failure ,SURVIVAL ,Cardiology ,Medicine ,IMPLANTATION ,business - Abstract
The superiority of transcatheter (TAVR) over surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS) has not been fully demonstrated in a real-world setting. This prospective study included 5706 AS patients who underwent SAVR from 2010 to 2012 and 2989 AS patients who underwent TAVR from 2017 to 2018 from the prospective multicenter observational studies OBSERVANT I and II. Early adverse events as well as all-cause mortality, major adverse cardiac and cerebrovascular events (MACCEs), and hospital readmission due to heart failure at 1-year were investigated. Among 1008 propensity score matched pairs, TAVR was associated with significantly lower 30-day mortality (1.8 vs. 3.5%, p = 0.020), stroke (0.8 vs. 2.3%, p = 0.005), and acute kidney injury (0.6 vs. 8.2%, p <, 0.001) compared to SAVR. Moderate-to-severe paravalvular regurgitation (5.9 vs. 2.0%, p <, 0.001) and permanent pacemaker implantation (13.8 vs. 3.3%, p <, 0.001) were more frequent after TAVR. At 1-year, TAVR was associated with lower risk of all-cause mortality (7.9 vs. 11.5%, p = 0.006), MACCE (12.0 vs. 15.8%, p = 0.011), readmission due to heart failure (10.8 vs. 15.9%, p <, 0.001), and stroke (3.2 vs. 5.1%, p = 0.033) compared to SAVR. TAVR reduced 1-year mortality in the subgroups of patients aged 80 years or older (HR 0.49, 95% CI 0.33–0.71), in females (HR 0.57, 0.38–0.85), and among patients with EuroSCORE II ≥ 4.0% (HR 0.48, 95% CI 0.32–0.71). In a real-world setting, TAVR using new-generation devices was associated with lower rates of adverse events up to 1-year follow-up compared to SAVR.
- Published
- 2021