Transcatheter Aortic Valve Replacement is More Effective than Surgical Aortic Valve Replacement in Decreasing Aortic Valve Gradient
Teng Lee1, Seyed Hossein Aalaei Andabili1, Thomas Beaver1, R. David Anderson2, John Petersen2, Anthony Bavry2, Charles Klodell1.
1Division of Thoracic and Cardiovascular Surgery, Gainesville, FL, USA, 2Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA.
OBJECTIVE: We investigated the effect of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) on aortic valve gradient (AG) among inoperable and operable patients with aortic stenosis.
METHODS: From March-2012 to September-2015, 563 consecutive patients underwent TAVR (n=419) or isolated SAVR (n=144). Post-op AG was evaluated with echo (within 30 days). AHA/ACC definitions include: mild (<20mmHg), moderate (20-40mmHg), and severe (>40mmHg) mean AG.
RESULTS: Among 563 patients, 463 (82.2%) (TAVR, n=381 and SAVR, n=82) had both preoperative and postoperative AG measurements. One hundred and seventeen (30.7%) patients in TAVR group and 54 (65.9%) patients in SAVR group underwent replacement with valve size ≤23mm. TAVR patients were significantly older and had more preoperative comorbidities than SAVR patients (Table 1), but mean preoperative AG and mean aortic valve area were not significantly different between two groups (Table 1). AG decreased significantly in both TAVR (42.0±15.3 vs 7.7±5.4, p<0.001) and SAVR (40.0±16.1 vs 14.2±8.2, p<0.001) groups after surgery. However, postoperative AG was significantly lower in TAVR group than SAVR group (Table 1). Prior to surgery, there was no difference in moderate or severe AG between TAVR and SAVR (Table 1); however, more SAVR patients had residual moderate or severe AG vs TAVR post-op (Table 1). Importantly, we found that patients who underwent SAVR with valve size ≤23mm were 3 times more likely to have greater than mild AG after surgery compared with TAVR patients who had surgery with valve size ≤23mm, OR: 3.1 (95% CI: 1.1-8.9). This association was not applicable for patients who had surgery with valve size >23mm. Change in AG was not associated with any other variable.
CONCLUSIONS: TAVR was more effective than SAVR in decreasing AG independent of patients’ baseline characteristics, especially in patients receiving a valve size ≤23mm.
Table-1. Patients’ baseline characteristics and study outcome
|Patients N (%)||381 (82.28)||82 (17.71)||-|
|Patients with valve size ≤23mm||117(30.70)||54 (65.85)||-|
|Male N (%)||207 (54.33)||58 (70.73)||0.009|
|Age (y) mean±SD||79.43±8.66||65.09±12.01||<0.001|
|PreOp AG (mmHg)||42.02±15.33||40.03±16.05||0.308|
|Smallest aortic area (cm2) mean±SD||0.67±0.23||0.72±0.21||0.124|
|Peripheral artery disease N (%)||61 (16.01)||3 (3.65)||0.002|
|Hypertension N (%)||320 (83.98)||55 (67.07)||0.001|
|Diabetes mellitus N (%)||143 (37.53)||23 (28.04)||0.127|
|Myocardial infarction N (%)||104 (27.29)||8 (9.75)||0.001|
|Heart failure N (%)||251 (65.87)||33 (40.24)||<0.001|
|Stroke N (%)||66 (17.3)||9 (10.97)||0.187|
|PreOp moderate/sever AG N (%)||356 (93.43)||74 (90.24)||0.342|
|PostOp AG (mmHg) mean±SD||7.74±5.39||14.27±8.16||<0.001|
|AG valve size≤ 23 mm||9.39±6.64||16.25±9.12||<0.001|
|AG valve size>23 mm||7.0±4.57||10.57±3.64||<0.001|
|PostOp mild AG N (%)||371 (97.37)||73 (89.02)||0.002|
|PostOp moderate/severe AG N (%)||10 (2.62)||9 (10.97)||0.002|
Back to 2017 Posters