Transcatheter aortic valve implantation versus surgery: 4-year survival according to life expectancy. in Journal of geriatric cardiology : JGC / J Geriatr Cardiol. 2024 Sep 28;21(9):846-854. doi: 10.26599/1671-5411.2024.09.005.
2024
AOU Città della Salute di Torino
AO Ordine Mauriziano
Tipo pubblicazione
Journal Article
Autori/Collaboratori (7)Vedi tutti...
Buono G
Department of Cardiovascular Anesthesia and Intensive Care, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy.
Centofanti P
Department of Cardiac Surgery, Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy.
Pidello S
Department of Cardioloy, Città della Salute e della Scienza Hospital, Turin, Italy.
et alii...
Abstract
BACKGROUND: In the last years, transcatheter aortic valve implantation (TAVI) indication has expanded to younger and lower risk patients. Consequently, interest in mid and long-term follow up and in the role of life expectancy, as a key factor for selecting the most tailored treatment, has grown. The aim of this retrospective study is to compare the 4-year survival of patients who underwent aortic valve replacement (AVR) vs. TAVI at our department. METHODS: From September 2017 to December 2020, 673 consecutive patients with severe aortic valve stenosis were enrolled for AVR (n = 283) or TAVI (n = 390). Inclusion criteria was isolated severe aortic stenosis, while exclusion criteria were redo surgery, valve-in-valve procedure and the need for concomitant surgical procedures. Based on the Lee index, patients were divided into four groups according to their 4-year life expectancy. Four-year survival was assessed and reported using the Kaplan-Meier method. A multivariate regression analysis of risk factors for 4-year mortality was performed. RESULTS: Four years survival is always superior in the AVR patients (89.8% vs. 75.6%, P < 0.001). Surgery is associated with a higher incidence of acute kidney injury (23% vs. 5.1%, P < 0.001), while TAVI is related to a higher incidence of new onset left bundle branch block (0 vs. 23.8%, P < 0.001), pace-maker implantation (2.5% vs. 11.8%, P = 0,02) and mild-to-moderate paravalvular leak (0.3% vs. 5.4%, P < 0.001). The independent risk factors for 4-years mortality are post-procedural AKI, poor mobility and transcatheter procedure. CONCLUSION: In our analysis, 4 years survival is always superior in the AVR patients. Life expectancy is a key factor for selecting the most appropriate approach for each patient. A longer follow up is mandatory before extending TAVI indication to patients with a long-life expectancy.
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PMID : 39483264
DOI : 10.26599/1671-5411.2024.09.005