1. The rise of new technologies for aortic valve stenosis: A comparison of sutureless and transcatheter aortic valve implantation
- Author
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Mauro Rinaldi, Claudia Filippini, Mauro Cassese, Marco Aiello, Pierluigi Stefàno, Ugolino Livi, Filippo Rapetto, Ottavio Alfieri, Bruno Borrello, Davide Gabbieri, Antonino S. Rubino, Fausto Biancari, Theodor Fischlein, Carlo Savini, Laura Besola, Augusto D'Onofrio, Stefano Salizzoni, Marco Agrifoglio, Antonio Colombo, Giuseppe Tarantini, Carmelo Mignosa, Giuseppe Gatti, Magnus Dalén, Bart Meuris, Gino Gerosa, D'Onofrio, Augusto, Salizzoni, Stefano, Rubino, A, Besola, Laura, Filippini, Claudia, Alfieri, Ottavio, Colombo, Antonio, Agrifoglio, Marco, Fischlein, Theodor, Rapetto, Filippo, Tarantini, Giuseppe, Dalèn, Magnu, Gabbieri, Davide, Meuris, Bart, Savini, Carlo, Gatti, Giuseppe, Aiello Marco, Luigi, Biancari, Fausto, Livi, Ugolino, Stefàno Pier, Luigi, Cassese, Mauro, Borrello, Bruno, Rinaldi, Mauro, Mignosa, Carmelo, and Gerosa, Gino
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Percutaneous ,Transcatheter aortic ,heart valve replacement ,030204 cardiovascular system & hematology ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Internal medicine ,medicine ,Humans ,aortic valve replacement ,Aged ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,heart valve replacement sutureless ,business.industry ,Incidence (epidemiology) ,Medicine (all) ,EuroSCORE ,Aortic Valve Stenosis ,medicine.disease ,heart valve replacement suturele ,Surgery ,percutaneou ,percutaneous ,transapical ,Cardiology and Cardiovascular Medicine ,030228 respiratory system ,Paravalvular leakage ,Aortic valve stenosis ,Propensity score matching ,Cardiology ,Female ,business - Abstract
Objective: Transcatheter aortic valve implantation (TAVI) and sutureless aortic valve replacement (SU-AVR) are suitable alternatives to conventional surgery. The aim of this study is to compare early outcomes of patients undergoing TAVI and SU-AVR.Methods: Data were analyzed on patients who underwent TAVI and patients who underwent SU-AVR. Two matched cohorts (TAVI vs SU-AVR) were created using propensity scores; all analyses were repeated for transapical TAVI and transfemoral TAVI, separately. Outcomes were defined according to Valve Academic Research Consortium-2 criteria.Results: A total of 2177 patients were included in the analysis: 1885 (86.6%) treated with TAVI; 292 (13.4%) treated with SU-AVR. Mortality in unmatched TAVI and SU-AVR patients was 7.1% and 2.1%, respectively, at 30 days, and 12.9% and 4.6%, respectively, at 1 year. No differences were found in 30-day mortality in the 214 matched patient pairs (3.7% vs 2.3%; P = .4), but patients treated with TAVI showed a lower incidence of device success (85.9% vs 98.6%; P < .001) and pacemaker implantation (2.8% vs 9.4%; P = .005), and a higher incidence of any paravalvular leakage (PVL).Conclusions: SU-AVR is associated with better device success and a lower incidence of PVL, compared with TAVI. Nevertheless, patients treated with SU-AVR were more likely to receive a permanent pacemaker. SU-AVR and TAVI provide good results in patients who have severe symptomatic aortic valve stenosis. Given the multiple therapeutic options available, patients may receive the treatment that is most appropriate for their clinical and anatomical characteristics.
- Published
- 2016