Early Critical Care Unit Outcome with Transcatheter Aortic Valve Intervention Compared to Surgical Aortic Valve Replacement in Severe Aortic Stenosis

Abstract

Abstract Background Aortic valve stenosis is the most common type of valvular diseases in the elderly population.1 Trans-catheter aortic valve implantation (TAVI) has been developed for minimally invasive treatment for patients considered ineligible for valve surgery. Although risk of early postprocedural complications and mortality were similar in TAVI vs Surgical aortic valve replacement (SAVR) yet risk of Permanent pacemaker implantation (PPI) and heart conduction disturbances are more common with TAVI.2,3 Patients and methods Our study was a prospective cohort study that included 60 patients diagnosed with severe aortic valve stenosis admitted to the National Heart Institute, Cairo, Egypt to undergo aortic valve replacement. After full assessment and eligibility, a multidisciplinary team enrolled patients consecutively to undergo aortic valve replacement by SAVR (20 patients) or TAVI (40 patients). The primary endpoint was the prevalence of mortality, early postprocedural complications. Secondary endpoints were the composite of post procedural in-hospital to 6 months all cause mortality and complications. Results Postprocedural conduction disorder evaluation showed LBBB was the most common conduction disorder, with higher incidence in TAVI vs SAVR group (27.5% vs 5%, P = .04). Similarly TAVI group was associated with higher incidence of total conduction disorders compared to SAVR group (50% vs 20%, P = .03). Although incidence of postprocedural complete heart block and requirement of permanent pacemaker implantation was higher in TAVI but this was non statistically significant. The risk of new onset Atrial fibrillation was higher with SAVR vs TAVI (25% vs 2.5%, P = .006). Although risk of bleeding increased in SAVR group yet there was no statistically significant difference between both groups. Major vascular complications were more frequent in TAVI vs SAVR group (7.5% vs 5%, P = .714). Both groups were similar regarding risk of mortality and incidence of other major complications as acute renal dysfunction, myocardial infraction and cerebrovascular stroke. Conclusion Although TAVI was followed by increased risk of conduction disorders and need for pacemaker implantation, and SAVR was associated with increased risk of life threating bleed. TAVI has proven to be a safer minimally invasive treatment option for severe aortic stenosis compared to the standard surgical approach.

Keywords

• CoreValve
• Edwards SAPIEN
• PPM implantation
• SAVR
• TAVI