Acquired cardiovascular disease
Sutureless replacement versus transcatheter valve implantation in aortic valve stenosis: A propensity-matched analysis of 2 strategies in high-risk patients

Read at the 39th Annual Meeting of The Western Thoracic Surgical Association, Coeur d’Alene, Idaho, June 26-29, 2013.
https://doi.org/10.1016/j.jtcvs.2013.10.025Get rights and content
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Objective

This propensity-matched study compared clinical and echocardiographic outcomes between patients undergoing transcatheter aortic valve implantation (TAVI) and sutureless aortic valve replacement.

Methods

From January 2010 to March 2012, 122 patients (age 79.4 ± 5.3 years, logistic euroSCORE 12% ± 8.4%) underwent minimally invasive sutureless aortic valve replacement, and 122 (age 84.6 ± 6.2 years, logistic euroSCORE 20.9% ± 2.5%) underwent TAVI. After propensity matching, 37 matched pairs were available for analysis.

Results

Preoperative characteristics and risk scores of matched groups were comparable. In-hospital mortalities were 0% in the sutureless group and 8.1% (n = 3) in the TAVI group (P = .24). Permanent pacemaker implantation was required in 4 patients in the sutureless group and 1 patient in the TAVI group (10.8% vs 2.7%; P = .18). A neurologic event was recorded in 2 patients of each group. Predischarge echocardiographic data showed higher paravalvular leak rate in the TAVI group (13.5% vs 0%; P = .027). At mean follow-up of 18.9 ± 10.1 months, overall cumulative survival was 91.9% and significantly differed between groups (sutureless 97.3% vs TAVI 86.5%; P = .015). In the TAVI group, a significant difference in mortality was observed between patients with (n = 20) and without (n = 17) paravalvular leak (25% vs 0%; P = .036).

Conclusions

Combining the advantage of standard diseased valve removal with shorter procedural times, minimally invasive sutureless aortic valve replacement may be the first-line treatment for high-risk patients considered in the “gray zone” between TAVI and conventional surgery.

CTSNet classification

28
28.1
35
35.2

Abbreviations and Acronyms

AVR
aortic valve replacement
CABG
coronary artery bypass grafting
CORONARY
Coronary Artery Bypass Surgery Off- or On-Pump Revascularization Study
PARTNER
Placement of AoRTic TraNscathetER Valve [trial]
TAVI
transcatheter aortic valve implantation
TRITON
Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve [trial]

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Disclosures: S.P. is a proctor and T.F. is a consultant for Sorin Group Srl, Saluggia, Italy. All other authors have nothing to disclose with regard to commercial support.

G.S. and S.P. contributed equally to this work.