Transcatheter versus surgical treatment for aortic stenosis: patient selection and early outcome

To describe short-term clinical and echocardiography outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). To explore patient selection criteria for treatment with TAVI.

TAVI patients (n = 45) were matched to SAVR patients (n = 45) with respect to age within ± 10 years, sex and systolic left ventricular function.

TAVI patients were older, 82 ± 8 versus 78 ± 5 years (p = 0.005) and they had higher logEuroSCORE, 16 ± 11% versus 8 ± 4% (p = 0.001). There were no significant differences in 30 days mortality, stroke and myocardial infarction. TAVI patients received less erythrocyte (53% vs. 78%, p = 0.03) and thrombocyte (7% vs. 27%, p = 0.02) transfusions. Postoperative atrial fibrillation was less common (18% vs. 60%, p = 0.001) in the TAVI group. Paravalvular regurgitation was more common in TAVI patients (87% vs. 0%, p = 0.001) and 27% had access site complications. Aortic transvalvular velocity was 2.3 ± 0.4 m/s versus 2.6 ± 0.5 m/s (p = 0.002) and mean valve pressure gradient was 12 ± 4 mmHg versus 15 ± 5 mmHg (p = 0.01) in the TAVI and SAVR groups, respectively. Twenty-nine (64%) of the TAVI patients had logEuroSCORE = 15%.

Both TAVI and SAVR have good short term clinical outcome with excellent hemodynamic result. In clinical practice, factors other than high logEuroSCORE play an important role in patient selection for TAVI.