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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Transapical versus conventional aortic valve replacement--a propensity-matched comparison.

David M Holzhey1, William Shi, A Rastan

  • 1Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany. dholzhey@web.de

The Heart Surgery Forum
|February 25, 2012
PubMed
Summary

Conventional aortic valve surgery offers superior long-term survival compared to transcatheter aortic valve implantation (TAVI). While TAVI shows similar short-term mortality, surgical AVR has better long-term outcomes for patients.

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Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Medical Technology Assessment

Background:

  • Aortic valve surgery is a critical intervention for severe aortic valve disease.
  • Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to conventional surgical aortic valve replacement (AVR).
  • Comparative outcome data between TAVI and conventional AVR are essential for clinical decision-making.

Purpose of the Study:

  • To compare short- and long-term outcomes of transapical transcatheter aortic valve implantation (taTAVI) versus conventional aortic valve replacement (AVR).
  • To evaluate periprocedural complications and long-term survival rates for both AVR approaches.

Main Methods:

  • A retrospective comparison of 336 taTAVI patients (2006-2010) and 4533 conventional AVR patients (2001-2010).
  • Propensity score matching created two comparable groups of 167 patients each.
  • Analysis focused on 30-day mortality, postoperative complications, and long-term survival.

Main Results:

  • 30-day mortality rates were similar: 10.8% for AVR and 8.4% for TAVI (P = .56).
  • TAVI group had higher rates of pacemaker implantation (15.0% vs 6.0%, P = .017) and renal failure requiring dialysis (25.7% vs 12.6%, P = .004).
  • Estimated 3-year survival rates favored conventional AVR (66.7%) over TAVI (53.5%).

Conclusions:

  • Conventional surgical AVR remains a highly effective treatment option, offering excellent long-term results.
  • Surgical AVR provides a robust alternative, even for older, high-risk patients.
  • Despite advancements, surgical AVR demonstrates superior long-term survival compared to taTAVI in this cohort.