227CONVENTIONAL VERSUS TRANSAPICAL AORTIC VALVE REPLACEMENT: IS IT TIME FOR INDICATION SHIFT?

• Published in: Interactive cardiovascular and thoracic surgery 2014-10, Vol.19 (suppl_1), p.S67-S67
• Main Authors: Ahad, S., Baumbach, H., Hill, S., Schaeufele, T., Beyer, M., Berroth, R., Franke, U.F.
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivu276.227

Objectives: Along with the increasing life expectancy, the incidence of degenerative aortic valve diseases rises simultaneously. Although the conventional aortic valve replacement (AVR) is the gold standard for symptomatic aortic stenosis, transcatheter procedures have proven to be a valid therapeutical option in high-risk patients. The aim of this study was the comparison of both procedures in this high-risk cohort. Methods: We retrospectively analysed all symptomatic (dyspnoea, NYHA class III or IV, or angina) high-risk patients (logistic EuroSCORE ≥15%) fulfilling the transcatheter aortic valve implantation (TAVI) indications. Most of the AVR group (n = 180) were operated before implementation of the TAVI programme. All TAVI procedures (n = 127) were performed transapically. After matching for age, logistic EuroSCORE, and left ventricular ejection fraction (LVEF), 82 pairs could be evaluated. Results: There was no difference between both groups regarding the survival after 1 year (Kaplan–Meier analysis) 81.5% (95% CI, 72%; 89%) vs 79.7% (95% CI, 67%; 85%) (log-rank P = 0.43) and the complication rates (AVR versus TA-TAVI; stroke 2 vs 0, P = 0.155; acute renal insufficiency 8 vs 12, P = 0.340; afibrillation 24 vs 26, P = 0.813; pacemaker implantation 4 vs 4, P = 1.00), respectively. Additionally, the quality of life did not differ between the groups. Patients of the TAVI group had lower mean valvular gradients postoperatively (15.5 ± 8.1 vs 10.6 ± 4.9, P < 0.001). Conclusion: For high-risk patients, the TAVI procedure allows acceptable results comparable to those of the conventional AVR group, but is not favourable. These results do not support the expansion of the TAVI indications to low- or intermediate-risk patients.