TRANSCATHETER AORTIC VALVE IMPLANTATION VERSUS MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT WITH SUTURELESS VALVE: A SINGLE CENTRE MATCHING STUDY
Francesca Chiaramonti, MD, PhD1, Giovanni Concistrč, MD1, Tommaso Gasbarri, MD, PhD1, Federica Marchi, MD, PhD1, Giacomo Bianchi, MD, PhD1, Danyar Gilmanov1, Pier Andrea Farneti, MD1, Sergio Berti, MD1, Mattia Glauber, MD2, Alfredo Giuseppe Cerillo, MD1, Marco Solinas, MD1.
1Heart Hospital G.Pasquinucci FTGM, Massa, Italy, 2Istituto Clinico Sant1Ambrogio, Milano, Italy.
Surgical aortic valve replacement (AVR) is still the treatment of choice for patients with severe symptomatic aortic valve stenosis (SSAVS). During few last years novel technologies, like transcatheter (TAVI) and sutureless bioprosthesis (whether or not with minimally invasive approaches) have shown early good results. The aim of this study was to compare early and mid-term outcomes of high-risk patients undergoing TAVI procedures versus patients undergoing minimally invasive aortic valve replacement (MIAVR) with sutureless or rapid-deployment bioprosthesis.
From January 2011 to December 2013, 69 patients with SSAVS underwent TAVI procedure at our centre (TAVI GROUP). This prospective cohort of patients was matched by four categories of risk profile and three categories of age, to a prospective cohort of patients undergoing MIAVR with a sutureless/rapid-deployment bioprosthesis from January 2011 and December 2013 (SUTURELESS GROUP, n=73 patients) at our centre. Was created a group of 40 pairs of patients with comparable preoperative risk profile and age.
Major/minor vascular complications were significantly more frequents in the TAVI group than in the SUTURELESS group (15.0% versus 0%, p=0.0255). Median mechanical ventilation time and Median ICU stay were significantly lower in TAVI group compared with SUTURELESS group. In SUTURELESS group the rate of new onset of AF was higher respect to TAVI group [38.5% (n= 15) vs. 10.8% (n= 4) respectively] (P=0.0083). At discharge and at one-year FU mean transvalvular gradient was comparable among two groups, while paravalvular regurgitation was more frequent after TAVI (P<0.001), but paravalvular regurgitation was not associated with increased one-year mortality (P>0.001). At discharge mortality rate was higher in TAVI group compared with SUTURELESS group (7.5% vs. 2.5%) (P=0.6153), but one-year mortality rate was 5.6 % (n= 2) in the TAVI group and 13.2% (n= 5) in the SUTURELESS group (P=0.4310), and the one-year cumulative mortality was not significantly different among two cohorts.
In high-risk patients with SSAVS, transcatheter procedures and MIAVR with sutureless/rapid-deployment bioprosthesis, were associated with similar rates of survival at one-year, although 30-days mortality was considerably lower in SUTURELESS group. Moreover there were some differences in periprocedural complications and mid-term outcomes.
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