Background: In recent years transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement (sAVR), particularly in the elderly. We sought to compare the clinical outcomes of these two interventional modalities, focusing on mid-term survival and quality of life (QOL).
Methods: The study population consisted of 187 consecutive patients age ≥75 undergoing AVR at our institution, and a QOL control group (n=88) of randomly selected healthy elderly subjects. Hospital data were extracted from our database and chart review. Follow-up data (23±13, 1-53 months) were obtained by direct patient contact. Health-related QOL was assessed by the SF-36 questionnaire, ADL and IADL. Primary end-points included 30-day mortality and morbidity, mid-term survival and QOL.
Results: Patients undergoing TAVI (n=101) were older than sAVR (±CABG, n=86) (83±4 vs. 79±3 years, p<0.001). The predicted risk of mortality calculated using the Society of Thoracic Surgeons algorithm was similar (TAVI 6±4% vs. sAVR 6±5%, p=0.25).
30-Day mortality, stroke and myocardial infarction rates were similar between the groups (Table and Figure). The TAVI group had substantially higher rates of vascular complications and pacemaker implantations. Survival after sAVR was higher.
ADL scores were similar, but IADL and SF-36 scores were significantly better after sAVR.
Conclusions: Both sAVR and TAVI were associated with low procedural mortality and acceptable morbidity.
TAVI was associated with a higher rate of pacemaker need and vascular complications. Mid-term survival and QOL were superior after sAVR. Despite the limitations inherent to its design and a learning curve, this study reflects a "snap-shot" of real-life practice in a tertiary academic center, emphasizing the concept that therapy for aortic stenosis patients should be offered by a cardio-surgical "heart-team" discussion.
