Transcatheter aortic valve implantation versus surgical aortic valve replacement: A propensity score analysis in patients at high surgical risk

Conradi, Lenard; Seiffert, Moritz; Treede, Hendrik; Silaschi, Miriam; Baldus, Stephan; Schirmer, Johannes; Kersten, Jan-Felix; Meinertz, Thomas; Reichenspurner, Hermann

doi:10.1016/j.jtcvs.2011.08.047

Cited by 56 publications

(34 citation statements)

References 21 publications

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“…Importantly, when adjusting or matching for the differences in both age and comorbidities between the groups, the survival was similar, as described in previous reports. 19 However, the trend for improved survival in SAVR was not entirely corrected by matching for typical risk factors. Thus, we believe that TAVR can be considered as a possible solution in older patients with significant comorbidities and anticipated PPM but should not be used as the first line of therapy in patients with a low risk of surgical AVR.…”

Section: Midterm Mortality and Outcomesmentioning

confidence: 99%

Hemodynamic performance and outcome of percutaneous versus surgical stentless bioprostheses for aortic stenosis with anticipated patient–prosthesis mismatch

Finkelstein¹,

Schwartz²,

Uretzky³

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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In patients with anticipated PPM, TAVR offers an immediate lower incidence of PPM than SAVR but a greater prevalence of aortic regurgitation. The differences in transaortic gradients became nonsignificant 3 months postoperatively. The question of whether TAVR is a suitable substitute for SAVR in patients with anticipated PPM, in particular, those who are older and sicker, warrants additional investigation.

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Section: Midterm Mortality and Outcomesmentioning

confidence: 99%

Hemodynamic performance and outcome of percutaneous versus surgical stentless bioprostheses for aortic stenosis with anticipated patient–prosthesis mismatch

Finkelstein¹,

Schwartz²,

Uretzky³

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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“…Procedural success, faster recovery and favourable clinical outcomes in the short term have been reported [7]. Overall mortality does not differ significantly between TAVI and traditional heart surgery, and duration of hospital stay is equal [8]. However, length of stay in intensive care unit is shorter for TAVI patients, though, 30 day mortality and risk of major stroke seems to be increased for the TAVI group [9].…”

Section: Introductionmentioning

confidence: 99%

Patient experiences of recovery after heart valve replacement: suffering weakness, struggling to resume normality

et al. 2013

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BackgroundHeart valve disease is becoming a public health problem due to increasing life expectancy and new treatment methods. Patients are at risk of developing depression, anxiety or post-traumatic stress disorder after heart valve surgery. To better plan proper care, describing and understanding patients’ perception of recovery after heart valve replacement is essential. The objective was to describe the experience of recovery at home after heart valve replacement.MethodsQualitative interviews were conducted with 10 patients representing the population and these were later transcribed. The analysis was inspired by Ricoeur’s theory of interpretation, which consists of three levels: naive reading, structured analysis, and critical interpretation and discussion.ResultsThe overall concept that emerged was suffering weakness and struggling to resume normality. Patients all struggled to resume normal living, both in regaining physical strength and in reestablishing balance in overall living. The overall concept can be interpreted in terms of the following themes: Disturbed network: Invaluable relatives, Contact with healthcare staff, Rehabilitation. Disturbed body: Stressful complications, Bodily attention, Physically affected, Physical capability. Recovery: Interrupted living, Suffering weakness, Gradual recovery, Achieving normality. Reflections: Thoughts about the procedure and Feeling sad and fragile.ConclusionThe study presents the main themes of network, body, recovery and reflection for ten patients after heart valve replacement. These main themes can overall be summarized as suffering weakness and struggling to resume normality. Patients felt weak with a changed body, but after a long recovery process regained vitality and returned to their daily life.

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“…According to a previous study, 30-day and 6-month survival rates following TAVI and SAVR were comparable, but TAVI was associated with shorter operation, intubation and intensive care unit times [1]. The selection of patients was based on expected perioperative or short-term mortality that is usually calculated from the two most common risk models – the logistic EuroSCORE [2] or the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) algorithms.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Utility of Biomarkers in Predicting of One-Year Outcomes in Patients with Aortic Stenosis Treated with Transcatheter or Surgical Aortic Valve Implantation

et al. 2012

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ObjectivesThe aim of the work was to find biomarkers identifying patients at high risk of adverse clinical outcomes after TAVI and SAVR in addition to currently used predictive model (EuroSCORE).BackgroundThere is limited data about the role of biomarkers in predicting prognosis, especially when TAVI is available.MethodsThe multi-biomarker sub-study included 42 consecutive high-risk patients (average age 82.0 years; logistic EuroSCORE 21.0%) allocated to TAVI transfemoral and transapical using the Edwards-Sapien valve (n = 29), or SAVR with the Edwards Perimount bioprosthesis (n = 13). Standardized endpoints were prospectively followed during the 12-month follow-up.ResultsThe clinical outcomes after both TAVI and SAVR were comparable. Malondialdehyde served as the best predictor of a combined endpoint at 1 year with AUC (ROC analysis) = 0.872 for TAVI group, resp. 0.765 (p<0.05) for both TAVI and SAVR groups. Increased levels of MDA, matrix metalloproteinase 2, tissue inhibitor of metalloproteinase (TIMP1), ferritin-reducing ability of plasma, homocysteine, cysteine and 8-hydroxy-2-deoxyguanosine were all predictors of the occurrence of combined safety endpoints at 30 days (AUC 0.750–0.948; p<0.05 for all). The addition of MDA to a currently used clinical model (EuroSCORE) significantly improved prediction of a combined safety endpoint at 30 days and a combined endpoint (0–365 days) by the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) (p<0.05).Cystatin C, glutathione, cysteinylglycine, asymmetric dimethylarginine, nitrite/nitrate and MMP9 did not prove to be significant. Total of 14.3% died during 1-year follow-up.ConclusionWe identified malondialdehyde, a marker of oxidative stress, as the most promising predictor of adverse outcomes during the 30-day and 1-year follow-up in high-risk patients with symptomatic, severe aortic stenosis treated with TAVI. The development of a clinical “TAVIscore” would be highly appreciated. Such dedicated scoring system would enable further testing of adjunctive value of various biomarkers.

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Transcatheter aortic valve implantation versus surgical aortic valve replacement: A propensity score analysis in patients at high surgical risk

Abstract: In our experience, mortality rates are similar after both types of procedure. Patients receiving TAVI benefit from faster postoperative recovery. Until more clinical data become available, the optimal procedure has to be determined for each patient according to individual risk factors.

Cited by 56 publications

References 21 publications

Hemodynamic performance and outcome of percutaneous versus surgical stentless bioprostheses for aortic stenosis with anticipated patient–prosthesis mismatch

Hemodynamic performance and outcome of percutaneous versus surgical stentless bioprostheses for aortic stenosis with anticipated patient–prosthesis mismatch

Patient experiences of recovery after heart valve replacement: suffering weakness, struggling to resume normality

Prognostic Utility of Biomarkers in Predicting of One-Year Outcomes in Patients with Aortic Stenosis Treated with Transcatheter or Surgical Aortic Valve Implantation

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