Conventional versus Transapical Aortic Valve Replacement: Is It Time for Shift in Indications?

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Increasing life expectancy has led to a rise in degenerative aortic valve diseases.
• Conventional aortic valve replacement (AVR) is the standard treatment for symptomatic aortic stenosis.
• Transcatheter aortic valve implantation (TAVI) offers a therapeutic alternative for high-risk individuals.

Purpose of the Study:

• To compare the outcomes of conventional AVR and transapical TAVI (TA-TAVI) in high-risk patients.
• To evaluate survival rates, complication incidence, and quality of life between the two procedures.

Main Methods:

• Retrospective analysis of symptomatic high-risk patients (logistic EuroSCORE ≥ 15%) eligible for TAVI.
• Comparison of 82 matched pairs of patients undergoing either AVR (n=180) or TA-TAVI (n=127).
• Matching criteria included age, logistic EuroSCORE, and left ventricular ejection fraction.

Main Results:

• No significant difference in 1-year survival rates between AVR and TA-TAVI groups (81.1% vs. 75.8%).
• Similar complication rates, including stroke, acute renal insufficiency, atrial fibrillation, and pacemaker implantation.
• TA-TAVI group showed lower postoperative mean valvular gradients compared to AVR (10.2 ± 4.9 mmHg vs. 14.6 ± 6.6 mmHg).

Conclusions:

• Transcatheter aortic valve implantation (TAVI) is a viable option for high-risk patients, comparable to conventional AVR.
• The TAVI procedure demonstrated no significant advantage over AVR in this high-risk cohort.
• Current findings do not support the extension of TAVI to low- or intermediate-risk patient populations.