Clinical Outcome and Cost Analysis of Sutureless Versus Transcatheter Aortic Valve Implantation With Propensity Score Matching Analysis

• Published in: The American journal of cardiology 2015-12, Vol.116 (11), p.1737-1743
• Main Authors: Santarpino, Giuseppe, MD, Pfeiffer, Steffen, MD, Jessl, Jürgen, MD, Dell'Aquila, Angelo, MD, Vogt, Ferdinand, MD, von Wardenburg, Che, MD, Schwab, Johannes, MD, Sirch, Joachim, MD, Pauschinger, Matthias, MD, Fischlein, Theodor, MD
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Aged; Aged, 80 and over; Aortic Valve Stenosis - economics; Aortic Valve Stenosis - surgery; Bioprosthesis; Cardiology; Cardiopulmonary Bypass; Cardiovascular; Chronic obstructive pulmonary disease; Clinical outcomes; Costs; Diabetes; Endoscopy; Female; Heart Valve Prosthesis; Hospital Costs; Hospitals; Humans; Laboratories; Logistics; Male; Matched-Pair Analysis; Ostomy; Patients; Propensity Score; Prostheses; Prosthesis Design; Pulmonary hypertension; Retrospective Studies; Standard deviation; Surgery; Transcatheter Aortic Valve Replacement; Treatment Outcome; Variables; Veins & arteries
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2015.08.043

Surgical sutureless and interventional transcatheter aortic valve prostheses are nowadays extensively adopted in high-risk elderly patients. An explorative analysis was carried out to compare the clinical outcome and costs associated to these approaches. Since 2010, a total of 626 patients were distributed between transcatheter aortic valve implantation (TAVI; n = 364) and sutureless (n = 262) groups. Patients of both groups were not comparable for clinical and surgical characteristics, but many patients were in a “gray zone”; therefore, a retrospective propensity score analysis was possible and performed. For the matched pair samples, postoperative, follow-up clinical data, and costs data were obtained. In-hospital death occurred in 5 patients in sutureless group and 3 patients in TAVI group (p = 0.36). Blood transfusions were higher in sutureless group (2.1 ± 2.3 vs 0.4 ± 1.0 U). TAVI group had a shorter intensive care unit and hospital stay (2.2 ± 2.7 vs 3.2 ± 3.5 days, p = 0.037; 12 ± 6 vs 14 ± 6 days, p = 0.017). No differences in postoperative neurologic (p = 0.361), renal (p = 0.106), or respiratory (p = 0.391) complications were observed between groups. At follow-up (24.5 ± 13.8 months), 1 patient in sutureless group and 7 patients in TAVI group died (p = 0.032). Paravalvular leakage occurred more frequently in patients in TAVI group (35 [34%] vs 7 [6.9%]; p