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Transcatheter aortic valve implantation (TAVI) remains the preferred strategy for high-risk or elderly individuals with aortic valve (AV) stenosis who are not considered to be optimal surgical candidates. Recent evidence suggests that low-risk patients may benefit from TAVI as well. The current study evaluates midterm survival in low-risk patients undergoing elective surgical AV replacement (SAVR) versus TAVI. The Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry (AVALON) compared isolated elective transfemoral TAVI or SAVR with sternotomy or minimally invasive approach in low-risk individuals performed between 2015 and 2019. Propensity score matching was conducted to determine SAVR controls for TAVI group in a 1-to-3 ratio with 0.2 caliper. A total of 2393 patients undergoing elective surgery (1765 SAVR and 629 TAVI) with median European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) score 1.81 (interquartile range [IQR], 1.36 to 2.53]) were initially included. Median follow-up was 2.72 years (IQR, 1.32-4.08; max 6.0). Propensity score matching returned 329 TAVI cases and 593 SAVR controls. Thirty-day mortality was 11 out of 329 (3.32%) in TAVI and 18 out of 593 (3.03%) in SAVR (risk ratio, 1.10; 95% CI, 0.52-2.37; P =.801) groups, respectively. At 2 years, survival curves began to diverge in favor of SAVR, which was associated with 30% lower mortality (hazard ratio, 0.70; 95% CI, 0.496-0.997; P =.048). Our data did not demonstrate a survival difference between TAVI and SAVR during the first 2 postprocedure years. After that time, SAVR is associated with improved survival. Extended observations from randomized trials in low-risk patients undergoing elective surgery are warranted to confirm these findings and draw definitive conclusions. [Display omitted] [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: Sutureless aortic prostheses provide an attractive opportunity for high-risk patients with difficult surgical anatomy of the aortic root. Aim of the study: To assess the outcomes of emergent aortic valve replacement (AVR) with Perceval sutureless bioprostheses in a group of high-risk patients in whom their implantation had not been considered before surgery. Material and methods: Since 2018, 53 sutureless aortic bioprostheses have been implanted in our center. In this single-center retrospective study, 7 high-risk (median EuroSCORE II 9.43%) patients (4 women and 3 men; median age 63 [28 to 73] years) were identified to undergo emergent procedures. They were operated on for active endocarditis on the native valves with extensive destruction of the annulus (n = 4), endocarditis on a previously implanted bioprosthesis (n = 1), organizing thrombus of the mechanical valve (n = 1), and diffuse aortitis (n = 1). Implantation feasibility, as well as postprocedural mortality and morbidity, were evaluated. Results: The following sizes of bioprostheses were used: XL (n = 3); L (n = 2); M (n = 1), and S (n = 1). The median (minimum; maximum) cross-clamping aortic time was 64 (37; 73) minutes while cardiopulmonary bypass time was 86 (49; 188) minutes, respectively. All patients survived operations and the first 30 days. Two of them died in the hospital because of multiorgan failure on 35th and 45th postoperative days. The follow-up period ranging from 6 to 40 months was completed by all who were discharged alive. Conclusions: Despite the well-known advantages of sutureless valves, they can be also used successfully in patients in whom standard prosthesis implantation is either impossible or highly demanding, including emergency cases with unexpected intraoperative findings. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Thoracic & Cardiovascular Surgery / Kardiochirurgia i Torakochirurgia Polska is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The best techniques for reduction of femoral access site complications after transcatheter aortic valve implantation (TAVI) remain the object of research. Aim: We report on a single center's experience with TAVI performed via the femoral access site. Material and methods: Between September 2010 and September 2015, 152 consecutive patients underwent TAVI in our department. Of them, 101 patients with CoreValve implantation from the femoral access site were included in the analysis. The femoral artery anatomy-tailored approach was introduced in 2013 in order to reduce the rate of access-site complications. Patients were assigned to percutaneous puncture or surgical cut-down depending on the femoral artery anatomy assessed in computed tomography. The study patients were divided into two subgroups: group A - patients treated before January 2013, before introduction of the tailored approach program (n = 34); and group B - patients treated between January 2013 and April 2015 (n = 67). Results: The access site complication rate significantly decreased from 35.3% in group A (n = 12) to 7.5% in group B (n = 5) (p = 0.0012). Both minor and major access site complications were more frequent in group A (p = 0.04 and 0.016, respectively). In-hospital mortality was 8.8% (n = 3) in group A and 1.5% (n = 1) in group B (p = 0.1). Conclusions: The femoral artery anatomy-tailored approach significantly reduces the incidence of access site complications in TAVI patients. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Thoracic & Cardiovascular Surgery / Kardiochirurgia i Torakochirurgia Polska is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)