Surgical Aortic Valve Replacement Wins The Hearts Of Intermediate And Low-risk Patients For Three Years Over Transcatheter Approach
Juan A. Siordia, Jr., Peter A. Knight.
University of Rochester Medical Center, Rochester, NY, USA.
OBJECTIVE: Transcatheter aortic valve replacement (TAVR) is a novel therapy for inoperable and high-risk patients with severe aortic stenosis. Long-term data comparing surgery and TAVR in intermediate-risk patients continues to undergo investigation. We sought to present a compilation of data addressing 3-year outcomes between the two interventions in intermediate and low-risk patients.
METHODS: A literature search finding randomized or observational, propensity-matched studies comparing the survival of intermediate and low-risk patients undergoing TAVR or surgical aortic valve replacement (SAVR) for severe aortic stenosis was performed. Intermediate and low-risk was defined by either an STS score ≤8%, EuroSCORE ≤20%, or EuroSCORE II ≤10%. Primary endpoints included 1-, 2-, and 3-year survival. Secondary endpoints included strokes, transient ischemic attacks (TIA), major vascular complications, permanent pacemaker implantation, life-threatening bleeding, acute kidney injury, and atrial fibrillation.
RESULTS: After exclusion, five studies were used to present 1- and 2-year data, and two studies were used for 3-year data. One-year and two-year survival were similar between the two therapies [OR (95% CI): 0.84 (0.70, 1.02) for 1-year and 0.79(0.52, 1.21) for 2-year]. Three-year survival was statistically significant in favor for SAVR compared to TAVR [OR (95% CI): 0.56 (0.42, 0.76)] (Figure 1). TAVR presented with more major vascular complications [OR (95% CI): 7.50 (1.81, 31.03)], permanent pacemaker implantation [OR (95%): 3.49 (1.65, 7.38)], and moderate-severe aortic regurgitation [OR (95% CI): 8.15 (4.04, 16.42)]. SAVR presented with more life-threatening bleeds [OR (95% CI): 0.36 (0.17, 0.78)], acute kidney injury [OR (95% CI): 0.51 (0.33, 0.79)], and atrial fibrillation [OR (95% CI): 0.35 (0.20, 0.60)]. Stroke and TIA were similar between the two groups.
CONCLUSIONS: SAVR presents with better long-term survival than TAVR for intermediate and low-risk patients. One and two-year survival is similar between the two interventions, but SAVR presents with statistically significant increased survival. Improvements in factors affecting transcatheter longevity are necessary in order to meet the standards of the surgical approach. Figure: 1-, 2-, and 3-year survival comparing TAVR vs SAVR.
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