Surgical versus trans-catheter aortic valve replacement (SAVR vs TAVR) in patients with aortic stenosis

Abstract

Trans-catheter aortic valve replacement (TAVR) has become an alternative to surgical aortic valve replacement (SAVR) in high and intermediate risk patients with aortic stenosis. TAVR programs are spreading from large referral centers and being established in community based institutions. The purpose of this study was to compare the outcomes of TAVR to those of SAVR in a community hospital.A historical cohort study of patients with aortic stenosis and pre-post procedure echocardiography data who underwent SAVR or TAVR in Cape Cod Hospital between January 2014 and December 2016. Patient characteristics and procedure outcomes were compared between the two procedures.The study included 230 patients, of them 111 underwent SAVR and 119 underwent TAVR. None of the patients died during the 30 days after the procedure. TAVR patients had higher rates of postoperative mild+ aortic regurgitation (AR) (29.4% vs 12.6%, P = .002), postoperative atrial ventricular blocks (11.8% vs 0.9%, P = .001), and more often need an implantation of pacemaker (16.8% vs 0.9%, P < .001). Postoperative mean gradient of SAVR patients was higher (median 14 vs 11 mm Hg, P = .001) and atrial fibrillation postoperatively was more frequent (18.9% vs 2.5%, P < .001). Length of stay after procedure was shorter in TAVR patients (median 2 vs 4 days, P < .001).After controlling for confounders, the use of TAVR was associated with an increased risk for postoperative pacemaker implantation (OR = 16.3, 95%CI 1.91–138.7, P = .011), lower mean gradient (−4.327, 95%CI −7.68 to −0.98, P = .011), and lower risk for atrial fibrillation (OR = 0.11, 95%CI 0.03–0.38, P = .001), but not with postoperative AR (OR = 0.84, 95%CI 0.22–3.13, P = .789).In conclusion, short-term mortality was not reported in SAVR or TAVR patients. However, TAVR was associated with an increased risk for postoperative pacemaker implantation but with a lower risk for atrial fibrillation. Aortic valves implanted through a trans-catheter approach are also associated with a better hemodynamic performance.

Surgical vs Transcatheter Aortic Valve Replacement in Patients With a Low Ejection Fraction

“…5 The valve size was significantly bigger with TAVR, similar to other studies. 19 SAVR had a more postoperative renal impairment and longer hospital stay, with no difference in stroke and hospital mortality between groups. In a meta-analysis comparing SAVR and TAVR, there were no differences in 30-day mortality, stroke, acute kidney injury, and myocardial infarction between groups.…”

Risk Factors for Delayed Atrioventricular Block after Aortic Valve Surgery: A Retrospective Study

“…It can be employed in patients dealing with aortic valve disease who are unsuitable for surgical valve replacement due to high-risk or surgical contraindications, ultimately enhancing their quality of life. Its clinical indications have gradually expanded to include patients at low surgical risk [2,3]. However, in the context of long-term clinical implementation of TAVR, complications related to cardiac block are commonly observed.…”

The application of 3D printing in preoperative planning for transcatheter aortic valve replacement: a systematic review

“…TAVR has received great attention for being less invasive compared to open-heart SAVR, with significant reduction in risk of strokes, major bleeding and atrial fibrillation [ 15 , 16 ]. Despite this, several complications are more prevalent in TAVR.…”