Right Mini Thoracotomy Sutureless Aortic Valve Replacement Versus Transcatheter Aortic Valve Implantation In Septuagenarian
SUCHART CHAIYAROJ, Varissara Javakijkarnjanakul, Chawannuch Ruaengsri, Omchai Rattananont, Mann Chantavimon, Oraporn See, Tawaii Ngernsritrakoon, Pawit Pienvijit, Somchai Viengteerawat, Panuwat Lertsittichai.
Fuculty of Medicine, Ramathibodi Hos[ital, Mahidol university, Bangkok, Thailand.
Background To report early, late clinical results and hemodynamics performance comparing right mini thoracotomy (RMT) suture less (SL) aortic valve replacement (AVR) and transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) in septuagenarian. Methods 175 consecutive severe AS patients underwent isolated AVR were non randomized prospectively reviewed during January 2003 to June 2017. Patients under 70 year old or full sternotomy AVR were excluded. There were 72 patients in the studies, 25 in RMT-SL AVR group (RMT-SL) and 47 in TAVI group. Early clinical outcomes of 30 days mortality, stroke, prolonged ventilation, renal failure, permanent pacemaker, and echocardiographic hemodynamic performance were assessed and compared between two groups. Late results were reported to June 2017. Results Mean age in RMT-SL and TAVI were 81.06±5.64, 76.24±6.08 (p=0.0013). The STS score and EURO II score in TAVI and SL group were 6.76±5.19, 5.51±3.26, p=0.745 and 8.75±9.97, 8.36±5.27, p=0.139. Paravalvular leakage (PVL) in RMT-SL and TAVI were 4%, 55.32 % (p = 0.003). New pace maker in RMT-SL group and TAVI were 0%, 17.02% (p = 0.029). Mean pressure gradient and effective orifice area at one year post implantation in RMT-SL and TAVI group were 6.52±0.51, 14.21±7.12 (p < 0.001) and 2.00±0.14, 1.64±0.30 (p = 0.001). Median follow up time (months) in RMT-SL and TAVI group were 25, 20 (p = 0.191). Late death in RMT-SL and TAVI group were 9%, 4% (p = 0.652). Survival rate at one and two year in RMT-SL and TAVI group were 100%, 94.72% (p < 0.001) and 100%, 87.43% (p < 0.001). Conclusions RMT approach using suture less aortic bio prosthesis for isolated severe AS in septuagenarian is associated with less PVL, less new pace maker, less late death, better effective hemodynamic performance, better early and midterm survival compared with TAVI.
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