Mini-Aortic Valve Replacement versus Transcatheter Aortic Valve Implantation: A Propensity-Matched Study

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2023-08-09 DOI:10.1155/2023/9501508

M. Monteagudo-Vela, Emilio Monguió-Santín, N. de Antonio Antón, Fernanda Aguirre, Begoña Bernal Gallego, Guillermo Reyes-Copa, V. Panoulas

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引用次数: 0

Abstract

Background. Total sternotomy for aortic valve replacement has been superseded by less invasive approaches such as mini-sternotomy or transcatheter procedures. There has been an exponential uptake in transcatheter aortic valve implantation (TAVI) in younger and lower risk patients following recent randomized trials. This study aims to compare the outcomes of patients with aortic stenosis treated with minimally invasive approaches: mini-sternotomy for aortic valve replacement (mini-AVR) and TAVI implantation. Methods. Between January 2015 and December 2021, a total of 1437 TAVI and 176 mini-AVR patients from 2 tertiary centers fulfilled the criteria and were included in the propensity matching model. Results. A total of 256 TAVIs and 146 mini-AVR were included in the matched cohort. There was no significant difference in 30-day mortality in the two groups (TAVI vs. mini-AVR 2.7% vs. 2.8%, p = 0.935 ). TAVI confers slightly lower gradients in the follow-up echo when compared with mini-AVR (peak gradient 20 ± 8.7 mmHg vs. 24.5 ± 10 mmHg, p < 0.001 ; mean gradient 10.9 ± 5.6 mmHg vs. 13.2 ± 5.7 mmHg, p < 0.001 ). On the other hand, mini-AVR exhibits remarkably lower rates of paravalvular leak (mild leak 8% vs. 41.5%, p < 0.001 ; moderate leak 2.8% vs. 0%, p < 0.001 ) and of need for permanent pacemaker implantation (2% vs. 12.2%, p < 0.001 ). Unsurprisingly, TAVI has lower in-hospital stay 3 (2 to 6) days vs. 10 (8 to 13) days, p < 0.001 ). Conclusions. For eligible aortic stenosis patients in the 7th decade of life, mini-AVR remains an excellent therapeutic option.

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小主动脉瓣置换术与经导管主动脉瓣植入术:倾向匹配研究

背景全胸骨切开术用于主动脉瓣置换术已被微创方法所取代，如小型胸骨切开术或经导管手术。在最近的随机试验之后，在年轻和低风险患者中，经导管主动脉瓣植入术（TAVI）的接受率呈指数级增长。本研究旨在比较采用微创方法治疗主动脉狭窄患者的结果：微创胸骨切开术治疗主动脉瓣置换术（mini-AVR）和TAVI植入术。方法。2015年1月至2021年12月，来自2个三级中心的1437名TAVI和176名迷你AVR患者符合标准，并被纳入倾向匹配模型。后果匹配队列中总共包括256个TAVI和146个迷你AVR。两组的30天死亡率没有显著差异（TAVI与迷你AVR的死亡率分别为2.7%和2.8%，p=0.935）。与迷你AVR相比，TAVI在随访回波中的梯度略低（峰值梯度20 ± 8.7 mmHg与24.5 ± 10 mmHg，p < 0.001；平均梯度10.9 ± 5.6 mmHg与13.2 ± 5.7 mmHg，p＜0.001）。另一方面，迷你AVR的瓣周渗漏率（轻度渗漏8%对41.5%，p＜0.001；中度渗漏2.8%对0%，p＜001）和需要植入永久性起搏器的比率（2%对12.2%，p＜0.01）显著较低。不出所料，TAVI的住院时间为3（2至6）天，低于10（8至13）天，p＜0.001）。结论。对于生命第7个十年中符合条件的主动脉狭窄患者，迷你AVR仍然是一个极好的治疗选择。

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.