Transcatheter aortic valve implantation versus surgery: 4-year survival according to life expectancy

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.

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.

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.

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.