- 作者：Paola D'Errigo ; Marco Barbanti ; Marco Ranucci ; Francesco Onorati ; Remo Daniel Covello ; Stefano Rosato ; Corrado Tamburino ; Francesco Santini ; Gennaro Santoro ; Fulvia Seccareccia ; on behalf of the OBSERVANT Research Group
- 关键词：Aortic stenosis ; TAVI ; SAVR ; Intermediate risk
- 刊名：International Journal of Cardiology
- 出版年：2013
- 出版时间：1 September, 2013
- 年：2013
- 卷：167
- 期：5
- 页码：1945-1952
- 全文大小：279 K
Background
Few studies have yielded information on comparative effectiveness of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) procedures in a real-world setting. The aim of this analysis is to describe procedural and post-procedural outcomes in a TAVI/SAVR intermediate risk propensity-matched population.Methods
OBSERVANT is an observational prospective multicenter cohort study, enrolling AS patients undergoing SAVR or TAVI. Propensity score method was applied to analyze procedural and post-procedural outcomes. Pairs of patients with the same probability score were matched (caliper matching).
Results
The unadjusted enrolled population (N = 2108) comprises 1383 SAVR patients, 602 transarterial-TAVI patients and 123 transapical-TAVI patients. Matched population comprised a total of 266 patients (133 patients for each group). A relatively low risk population was selected (mean logistic EuroSCORE 9.4 ¡À 10.4 % vs 8.9 ¡À 9.5 % , SAVR vs TAVI; p = 0.650). Thirty-day mortality was 3.8 % for both SAVR and TAVI (p = 1.000). The incidence of stroke (1.5 % SAVR and 0.0 % TAVI; p = 0.156) and myocardial infarction (0.8 % SAVR and 0.8 % TAVI; p = 1.000) was not statistically different between groups, whereas a higher requirement for blood transfusion was reported across the surgical cohort (49.6 % vs 36.1 % ; p = 0.026). A higher incidence of major vascular damage (5.3 % vs. 0.0 % ; p = 0.007) and pacemaker implantation(0.8 % vs 12.0 % ; p = 0.001) were reported in the TAVI group.
Conclusions
Patients undergoing transcatheter and surgical treatment of severe aortic stenosis are still extremely distinct populations. In the relatively low-risk propensity-matched population analyzed, despite similar procedural and 30-day mortality, SAVR was associated with a higher risk for blood transfusion, whereas TAVI showed a significantly increased rate of vascular damage, permanent AV block and residual aortic valve regurgitation.