Trans-catheter Valve Implantation (TAVI) Versus Sutureless Aortic Valve Replacement in Elderly Patients
2Cardiology Department, Chaim Sheba Medical Center, Sackler School of Medicine, Tel- Aviv University, Israel
Background: The increasing number of elderly patients requiring aortic valve replacement raises the question regarding the most appropriate treatment strategy for high risk population. The aim of the study was to compare the clinical and echocardiographic outcomes of patients undergoing transcatheter (TAVI) versus surgical aortic valve replacement with the sutureless bioprosthesis (SU-AVR).
Methods: Consecutive patients undergoing TAVI or SU-AVR in Sheba Medical Center between 2008 and 2015 were included in the analysis. Baseline characteristics and VARC-2 outcomes were compared between groups.
Results: 535 patients underwent TAVI (age 83±7.6, STS 5.4±3.7, Euroscore II 5.6±6.2) and 78 patients (age 78±20, STS 4.3±2.5, Euroscore II 4.4±3.2) underwent isolated SU-AVR. Stroke was recorded in 3.7% (n=20) in the TAVI vs. 2.5% (n=2) in the SU-AVR group (p=0.7). Permanent pacemaker implantation was required in 7.6% (n=4) in the TAVI group vs. 3.8% (n=3) in the SU-AVR group (p=0.1). There was higher mild paravalvular leak rate in the TAVI group (15.5% vs. 0, p=0.02). Postoperative peak and mean gradient were not significantly different between the TAVI and SU-AVR (18±12 vs. 20±26, 11±8 vs. 10.5±4.7, p=1, p=0.3) respectively. There was no significant change in the mean pre- and postoperative EF in both groups. In-hospital mortality was2.5% (n=2) in the SU-AVR group and 2% (n=11) in the TAVI group (p=0.8).
Conclusions: In elderly, high risk patients with severe aortic stenosis SU-AVR and TAVI provide good clinical and echocardiographic results.
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