Midterm Outcomes Following Sutureless and Transcatheter Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis.

Aortic Valve / diagnostic imaging Aortic Valve Stenosis / diagnostic imaging Heart Valve Prosthesis Implantation / adverse effects Humans Risk Factors Transcatheter Aortic Valve Replacement / adverse effects Treatment Outcome
aortic valve stenosis heart failure mortality prostheses and implants stroke

Journal

Circulation. Cardiovascular interventions
ISSN: 1941-7632
Titre abrégé: Circ Cardiovasc Interv
Pays: United States
ID NLM: 101499602

Informations de publication

Date de publication:
11 2021
Historique:
pubmed: 6 10 2021
medline: 23 11 2021
entrez: 5 10 2021
Statut: ppublish

Résumé

Sutureless-surgical aortic valve replacement (SU-SAVR) has been proposed as a surgical alternative for treating aortic stenosis, which facilitates a minimally invasive approach. While some studies have compared the early outcomes of SU-SAVR versus transcatheter aortic valve replacement (TAVR), most data were obtained in high-risk patients and/or limited to in-hospital outcomes. This study aimed to compare in-hospital and midterm clinical outcomes following SU-SAVR and TAVR in low-risk patients with aortic stenosis. A total of 806 consecutive low-risk (EuroSCORE II <4%) patients underwent TAVR or SU-SAVR between 2011 and 2020 in 2 centers. A 1:1 propensity score matching was performed and identified 171 pairs with similar characteristics that were included in the analysis. Baseline characteristics, in-hospital and follow-up events (defined according to Valve Academic Research Consortium-2) were collected. Baseline characteristics were well balanced between groups, with a median EuroSCORE II of 1.9% (1.3%-2.5%) in both SU-SAVR and TAVR groups ( In low-risk patients with aortic stenosis, TAVR was associated with improved in-hospital outcomes (except for conduction disturbances) and valve hemodynamics, compared with SU-SAVR. Although similar mortality and stroke rates were observed at 2-year follow-up, the risk of heart failure hospitalization was higher among SU-SAVR patients. These results may contribute to reinforce TAVR over SU-SAVR for the majority of such patients. Graphic Abstract: A graphic abstract is available for this article.

Sections du résumé

BACKGROUND
Sutureless-surgical aortic valve replacement (SU-SAVR) has been proposed as a surgical alternative for treating aortic stenosis, which facilitates a minimally invasive approach. While some studies have compared the early outcomes of SU-SAVR versus transcatheter aortic valve replacement (TAVR), most data were obtained in high-risk patients and/or limited to in-hospital outcomes. This study aimed to compare in-hospital and midterm clinical outcomes following SU-SAVR and TAVR in low-risk patients with aortic stenosis.
METHODS
A total of 806 consecutive low-risk (EuroSCORE II <4%) patients underwent TAVR or SU-SAVR between 2011 and 2020 in 2 centers. A 1:1 propensity score matching was performed and identified 171 pairs with similar characteristics that were included in the analysis. Baseline characteristics, in-hospital and follow-up events (defined according to Valve Academic Research Consortium-2) were collected.
RESULTS
Baseline characteristics were well balanced between groups, with a median EuroSCORE II of 1.9% (1.3%-2.5%) in both SU-SAVR and TAVR groups (
CONCLUSIONS
In low-risk patients with aortic stenosis, TAVR was associated with improved in-hospital outcomes (except for conduction disturbances) and valve hemodynamics, compared with SU-SAVR. Although similar mortality and stroke rates were observed at 2-year follow-up, the risk of heart failure hospitalization was higher among SU-SAVR patients. These results may contribute to reinforce TAVR over SU-SAVR for the majority of such patients. Graphic Abstract: A graphic abstract is available for this article.

Identifiants

DOI: 10.1161/CIRCINTERVENTIONS.121.011120 PMID: 34607449
pubmed: 34607449
doi: 10.1161/CIRCINTERVENTIONS.121.011120
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e011120

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Auteurs

Victoria Vilalta (V)

Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).
CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).
Department of Medicine, Universitat Autònoma de Barcelona, Spain (V.V., A.B.-G.).
ORCID: 0000-0003-1767-5963

Alberto Alperi (A)

Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.).
ORCID: 0000-0002-9939-8949

Germán Cediel (G)

Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).
CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).
ORCID: 0000-0001-9667-7507

Siamak Mohammadi (S)

Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.).
ORCID: 0000-0001-7622-4172

Eduard Fernández-Nofrerias (E)

Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).
CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).
ORCID: 0000-0003-2219-921X

Dimitri Kalvrouziotis (D)

Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.).

Robert Delarochellière (R)

Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.).

Jean-Michel Paradis (JM)

Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.).

Marta González-Lopera (M)

Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).

Edgar Fadeuilhe (E)

Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).
CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).

Xavier Carrillo (X)

CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).
ORCID: 0000-0001-6691-8859

Omar Abdul-Jawad Altisent (O)

Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).
CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).
ORCID: 0000-0002-8884-0172

Oriol Rodríguez-Leor (O)

Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).
CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).

Pierre Voisine (P)

Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.).

Antoni Bayés-Genís (A)

Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).
CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).
Department of Medicine, Universitat Autònoma de Barcelona, Spain (V.V., A.B.-G.).
ORCID: 0000-0002-3044-197X

Josep Rodés-Cabau (J)

Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.).
Hospital Clínic de Barcelona, Spain (J.R.-C.).
ORCID: 0000-0001-8237-7095

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Classifications MeSH

questionsmedicales.fr › Système cardiovasculaire › Coeur › Valves cardiaques › Valve aortique › Midterm Outcomes Following Sutureless and...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Obstacle à l'éjection ventriculaire › Sténose aortique › Midterm Outcomes Following Sutureless and...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie thoracique › Procédures de chirurgie cardiaque › Implantation de valve prothétique cardiaque › Midterm Outcomes Following Sutureless and...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Midterm Outcomes Following Sutureless and...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Midterm Outcomes Following Sutureless and...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie thoracique › Procédures de chirurgie cardiaque › Implantation de valve prothétique cardiaque › Remplacement valvulaire aortique par cathéter › Midterm Outcomes Following Sutureless and...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Midterm Outcomes Following Sutureless and...