Isolated surgical vs. transcatheter aortic valve replacement: a propensity score analysis

Abstract

Abstract Background The debate about the optimal approach for aortic valve replacement continues. We compared the hospital and long-term outcomes (survival, aortic valve reintervention, heart failure readmissions, and stroke) between transcatheter vs. surgical (TAVR vs. SAVR) aortic valve replacement. The study included 789 patients; 293 had isolated SAVR, and 496 had isolated TAVR. Patients with concomitant procedures were excluded. Propensity score matching identified 53 matched pairs. Results Patients who had TAVR were significantly older (P ˂ 0.001) and had significantly higher EuroSCORE II (P ˂ 0.001), NYHA class (P ˂ 0.001), and more prevalence of diabetes mellitus (P ˂ 0.001), hypertension (P ˂ 0.001), chronic lung disease (P = 0.001), recent myocardial infarction (P = 0.002), and heart failure (P ˂ 0.001), stroke (P = 0.02), atrial fibrillation (P = 0.004), and previous percutaneous coronary interventions (P ˂ 0.001) than SAVR patients. In the matched cohort, atrial fibrillation occurred more frequently after SAVR (P = 0.01), and hospital stay was significantly longer in SAVR patients (P ˂ 0.001). There were no differences in hospital mortality between groups (P ˃ 0.99). Survival at 1, 3, and 5 years was 97%, 95%, and 94% for SAVR and 91%, 79%, and 58% for TAVR patients. Survival was lower in TAVR patients before matching (P ˂ 0.001) and after matching (P = 0.045). Freedom from the composite endpoint of stroke, aortic valve reintervention, and heart failure readmission at 1, 3, and 5 years was 98.9%, 96%, and 94% for SAVR and 94%, 86%, and 75% for TAVR. The composite endpoint was significantly higher in the TAVR group than in SVR before matching (P ˂ 0.001), while there was no difference after matching (P = 0.07). There was no significant difference in the change in ejection fraction between groups (β: −0.88 (95% CI: −2.20–0.43), P = 0.19), and the reduction of the aortic valve peak gradient was significantly higher with TAVR (β: −7.80 (95% CI: −10.70 to −4.91); P ˂ 0.001). Conclusions TAVR could reduce postoperative atrial fibrillation and hospital stay. SAVR could have long-term survival benefits over TAVR with comparable long-term stroke, heart failure readmission, and aortic valve reinterventions between SAVR and TAVR.

Keywords

• Surgical aortic valve replacement
• Transcatheter aortic valve replacement
• Survival
• Reinterventions