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

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• 作者：Nicolo Piazza ; MD ; PhD^? ; ^&dagger ; ; Bindu Kalesan ; PhD^&Dagger ; ; Nicolas van Mieghem ; MD^§ ; ; Stuart Head ; MSc^¡Î ; Peter Wenaweser ; MD^¶ ; ; Thierry P. Carrel ; MD^# ; Sabine Bleiziffer ; MD^? ; ^&dagger ; ; Peter P. de Jaegere ; MD ; PhD^§ ; ; Brigitta Gahl^# ; Robert H. Anderson ; MD ; PhD^?? ; Arie-Pieter Kappetein ; MD ; PhD^¡Î ; Ruediger Lange ; MD ; PhD^? ; ^&dagger ; ; Patrick W. Serruys ; MD ; PhD^§ ; ; Stephan Windecker ; MD^¶ ; ; Peter Jü ; ni ; MD^&Dagger ; ; ^{juni@ispm.unibe.ch}
• 关键词：aortic stenosis ; intermediate surgical risk ; SAVR ; surgical aortic valve replacement ; SURTAVI ; TAVI ; transcatheter aortic valve implantation ; transcatheter aortic valve replacement
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2013
• 出版时间：May, 2013
• 年：2013
• 卷：6
• 期：5
• 页码：443-451
• 全文大小：492 K

文摘

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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]; )