Transcatheter vs. surgical aortic valve replacement
| Autor: | Manuela Muratori, Veronica Bona, Melissa Fusari, Luca Salvi, Gloria Tamborini, Paolo Biglioli, Stefano Salis |
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| Rok vydání: | 2012 |
| Předmět: |
Male
Cardiac Catheterization medicine.medical_specialty Time Factors Clinical effectiveness Kaplan-Meier Estimate Risk Assessment Severity of Illness Index Postoperative Complications Aortic valve replacement Risk Factors Internal medicine Retrospective analysis Humans Medicine Hospital Mortality Propensity Score Aged Retrospective Studies Aged 80 and over Heart Valve Prosthesis Implantation Chi-Square Distribution business.industry Patient Selection Mortality rate Incidence (epidemiology) Confounding Aortic Valve Stenosis General Medicine Length of Stay medicine.disease Intensive Care Units Stenosis Logistic Models Treatment Outcome Italy Multivariate Analysis Propensity score matching Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Cardiovascular Medicine. 13:229-241 |
| ISSN: | 1558-2027 |
| DOI: | 10.2459/jcm.0b013e3283515c0f |
| Popis: | OBJECTIVE To compare, in terms of clinical effectiveness and safety, patients who underwent transcatheter aortic valve implantation (TAVI) with those who underwent surgical aortic valve replacement (S-AVR) for the treatment of severe aortic stenosis during the same period. METHODS One hundred and eighty-seven consecutive patients were included: 81 with S-AVR and 106 with TAVI. Primary and secondary outcomes were reported in accordance with published reporting guidelines for valve surgery. A propensity matching model was computed in the attempt to reduce confounding effects of covariates. RESULTS Thirty-day mortality and morbidity, as well as follow-up events, did not differ between the two therapeutic options, except for ICU stay, in favor of TAVI, and occurrence of pleural effusions, in favor of S-AVR. TAVI accomplished significant mean aortic gradient reduction (better than S-AVR in the immediate postoperative and at least comparable at follow-up) and improvement in valve area and functional class (always higher than S-AVR). Although for the first year, survival was at least comparable between TAVI and S-AVR (both whole and matched groups); at later times, TAVI all-cause and noncardiac mortality was higher in the whole sample, as expected from age and comorbidities of TAVI patients. At later follow-up, in the matched subsamples, 1-year mortality rates were replicated, with a significantly higher incidence of cardiac deaths in S-AVR patients. CONCLUSION TAVI morbidity and mortality registered in this series are lower than those estimated for conventional surgery in high-risk patients and compare to those associated with S-AVR in good surgical candidates. |
| Databáze: | OpenAIRE |
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