Transcatheter aortic valve implantation versus surgery in low-risk patients: in-hospital and mid-term outcomes.

Abstract

Objectives: The aim of our study is to compare post-procedural outcomes and mid-term mortality of low-risk patients treated by transfemoral TAVI or surgical aortic valve replacement (AVR) for severe aortic stenosis.

Methods: Data of consecutive patients undergoing AVR or TAVI from September 2017 to December 2021 were prospectively collected and retrospectively reviewed. Eligible patients were aged between 75 and 85 years with low-surgical risk and isolated severe aortic stenosis. Exclusion criteria were prior heart surgery, valve-in-valve procedure and the need for concomitant procedures. The primary end-point was mid-term all-cause mortality.

Results: Three hundred fifty-one patients were enrolled. Of these, 243 underwent TAVI and 108 underwent AVR. Compared to AVR, TAVI patients were older (82 [78-83 ] vs 78 [77-80], P < 0.001), with higher incidence of advanced chronic kidney disease (33.3% vs 15.7%, P < 0.001) and poor mobility (15.6% vs 5.6%, P = 0.008) and a higher Euroscore II (2.2 [1.72-2.98] vs 1.9 [1.31-2.46 ], P = 0.002). AVR patients had a higher incidence of post-procedural AKI (29.6% vs 4.5%, P < 0.001), while TAVI patients had a higher incidence of LBBB (23.9% vs 1.8%, P < 0.001) and at least mild to moderate PVL (4.5% vs 0%, P = 0.021). Mid-term mortality was higher among TAVI patients (HR 0.38 [95% CI 0.23-0.88], P = 0.020). In the matched cohort, TAVI had a higher incidence of LBBB (11.5% vs 1.3%, P = 0.018) and permanent PM implantation (12.8% vs 5.1%, P = 0.041), while AVR patients had a higher incidence of post-procedural AKI (33.3% vs 5.1%, P < 0.001). Mid-term mortality was higher in TAVI patients (HR 0.36 [95% CI 0.21-0.87], P = 0.019).

Conclusions: TAVI patients demonstrated a higher mid-term mortality and a higher incidence of post-procedural conduction abnormalities and PVL which remain a concern in low-risk patients.