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Minimally invasive surgical versus transcatheter aortic valve replacement: A multicenter study
Domenico Paparella1,2, Giuseppe Santarpino3,4, Pietro Giorgio Malvindi1
1Santa Maria Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari, Italy.
Summary
Minimally invasive surgical aortic valve replacement (mini-SAVR) and transcatheter aortic valve implantation (TAVI) are safe for elderly patients with comorbidities. A heart team approach ensures optimal treatment selection for aortic stenosis.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Aortic stenosis treatment is evolving with increased use of transcatheter aortic valve implantation (TAVI) and minimally invasive surgical approaches (mini-SAVR).
- Comparative studies between mini-SAVR and TAVI are limited, especially in recent cohorts.
Purpose of the Study:
- To compare the safety and efficacy of mini-SAVR versus TAVI in a multicenter cohort of patients with aortic stenosis.
- To evaluate short-term outcomes, including mortality and major complications, for both procedures.
Main Methods:
- A total of 2904 patients (2407 mini-SAVR, 497 TAVI) from 10 centers (2011-2016) were analyzed.
- Propensity score matching was used to compare outcomes between groups with similar baseline characteristics.
- Primary outcome was 30-day mortality; secondary outcomes included major complications.
Main Results:
- In the overall population, TAVI patients had higher surgical risk and 30-day mortality.
- After propensity matching, no significant difference in 30-day mortality or stroke was observed between mini-SAVR and TAVI.
- Mini-SAVR was associated with more blood transfusions, kidney dysfunction, and longer ICU/hospital stays, while TAVI required more permanent pacemaker insertions.
Conclusions:
- Both mini-SAVR and TAVI are safe and effective treatment options for elderly patients with aortic stenosis and comorbidities.
- A heart team evaluation is crucial for selecting the most appropriate treatment strategy for individual patients.
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