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Clinical Research
A 3-Center Comparison of 1-Year Mortality Outcomes Between Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement on the Basis of Propensity Score Matching Among Intermediate-Risk Surgical Patients

https://doi.org/10.1016/j.jcin.2013.01.136Get rights and content
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Objectives

This study sought to compare all-cause mortality in patients at intermediate surgical risk undergoing transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR).

Background

Physicians are selecting “lower” surgical risk patients to undergo TAVI. No clinical data exist about the clinical outcomes of TAVI versus SAVR among intermediate-surgical-risk patients.

Methods

We prospectively enrolled symptomatic patients with severe aortic stenosis who underwent TAVI or SAVR. Propensity-score matched pairs of TAVI and SAVR patients with Society of Thoracic Surgeons (STS) scores between 3% and 8% made up the study population. Primary endpoint was all-cause mortality at 1 year.

Results

Between November 2006 and January 2010, 3,666 consecutive patients underwent either TAVI (n = 782) or SAVR (n = 2,884). Four hundred five TAVI patients were matched to 405 SAVR patients. Of matched TAVI patients, 99 (24%) patients had STS scores <3%, 255 (63%) had scores between 3% and 8%, and 51 (13%) had scores >8%. Among patients with STS scores between 3% and 8%, 20 (7.8%) versus 18 (7.1%) patients had died up to 30 days (hazard ratio: 1.12, 95% confidence interval: 0.58 to 2.15, p = 0.74) and 42 (16.5%) versus 43 (16.9%) patients had died up to 1 year (hazard ratio: 0.90, 95% confidence interval: 0.57 to 1.42, p = 0.64) after TAVI and SAVR, respectively. Effects of treatment on 1-year mortality were similar across all subgroups except for sex, with some evidence for a beneficial effect of TAVI in women but not in men (test for interaction p = 0.024).

Conclusions

Cumulative all-cause mortality at 30 days and 1 year was similar among propensity-score matched TAVI and SAVR patients at intermediate surgical risk. (Surgical Replacement and Transcatheter Aortic Valve Implantation [SURTAVI]; NCT01586910)

Key Words

aortic stenosis
intermediate surgical risk
SAVR
surgical aortic valve replacement
SURTAVI
TAVI
transcatheter aortic valve implantation
transcatheter aortic valve replacement

Abbreviations and Acronyms

CI
confidence interval
EuroSCORE
European System for Cardiac Operative Risk Evaluation
HR
hazard ratio
LVEF
left ventricular ejection fraction
NYHA
New York Heart Association
OR
odds ratio
SAVR
surgical aortic valve replacement
STS
Society of Thoracic Surgeons
TAVI
transcatheter aortic valve implantation

Cited by (0)

Dr. Piazza has served as consultant for Medtronic, HighLife, and CardiaAQ; and steering committee member for the SURTAVI trial. Dr. van Mieghem has served as study chair and steering committee member for the SURTAVI trial. Dr. Wenaweser has served as proctor for Medtronic and Edwards Lifesciences; is a consultant for Biotronik; has received honoraria/lecture fees from Medtronic and Edwards Lifesciences; and has received honoraria from Biotronik. Dr. Bleiziffer has served as consultant for Medtronic and Edwards Lifesciences; and as a proctor for Medtronic and JenaValve. Dr. de Jaegere has served as consultant for Medtronic. Dr. Kappetein has served as principal investigator for the SURTAVI trial. Dr. Lange has served on the advisory board and as consultant for Medtronic; and principal investigator for the SURTAVI trial. Dr. Serruys has served as Study Chair for the SURTAVI trial. Dr. Windecker has served as principal investigator for the SURTAVI trial; been supported by grants to the institution from Medtronic, Edwards Lifesciences, Abbott, Cordis, Biotronik, Boston Scientific, Biosensors, and St. Jude; and has received lecture fees from Edwards Lifesciences and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Dr. Piazza and Dr. Kalesan contributed equally to this work.