Objective: he decision to perform TAVR rather than SAVR is based mainly on assessment of operative risk using the current surgical risk calculators (STS score and Euro-score)
The good results of TAVR in high-risk patients have led a tendency to use TAVR in patients with lower risk. The purpose of this report is to compare intermediate term survival of TAVR and SAVR and evaluate additive euroscore I (A known criteria to predict early outcome) as a criteria to differentiate patients with better midterm outcome.
Methods: Between Januar 2009 to April 2014 there were 491 TAVR patient that were compared to 278 SAVR patient treated in our center, operated on between 1997-2014.
Inclusion criteria was severe symptomatic aortic stenosis ((BSAx. EOA2/m2)). Patients with bacterial- endocarditis and patients with aortic root enlargement were excluded. Additive Euro score I of 10 was used to differentiate between high risk and lower risk patients.
Results: Older age( 82+ 4 vs 71 + 9, P< 0.001.) female gender (56.7% vs 47.3% p= 0.007) chronic obstructive lung disease[ (COPD) 17.2% vs 5.7%, P<0.001], prior coronary artery bypass surgery (CABG) (18.4% vs 7.2%, p%vs.9.7% p
Thirty-day mortality of the two groups was similar (2.4% vs. 4.3%, in the TAVR and SAVR groups respectively p=0.110)
Four years survival (Kaplan-Meier) of the SAVR patients with Additive Euro score I up to 10 was better (94.1+ 2% vs. 70.7+ 6%, p
Assignment to TAVR was also found to be a significant risk factor for decreased propensity adjusted survival in patients with Euro-score <10 (HR.3.052 95 % CI.1.075-8.667). Other predictors of decreased survival were :age, prior CABG and PVD.
Conclusions: Mid-term outcome of SAVR patients with Euro-score up to 10 is better , TAVR may be recommended for patients with euro-score > 10.
