Transcatheter Versus Minimally Invasive Surgical Aortic Valve Replacement With Rapid-Deployment Valves: A...

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Biomedical Engineering

Background:

• Severe aortic stenosis (AS) necessitates valve replacement.
• Transfemoral transcatheter aortic valve replacement (TF-TAVR) is a common treatment.
• Minimally invasive surgical aortic valve replacement (MI-SAVR) with rapid-deployment (RD) valves offers an alternative approach.

Purpose of the Study:

• To compare intermediate-term survival and valve-related complications.
• Evaluate MI-SAVR with RD valves versus TF-TAVR.
• Analyze outcomes in a propensity-matched cohort.

Main Methods:

• Retrospective review of patients undergoing isolated MI-SAVR with RD valve or TF-TAVR.
• Propensity score matching (1:1 ratio) applied to create comparable groups.
• Analysis of operative mortality, perioperative stroke, paravalvular leakage, pacemaker implantation, and survival.

Main Results:

• MI-SAVR had 0% operative mortality versus 3.3% for TF-TAVR (p=0.03).
• At 3 years, MI-SAVR showed significantly lower rates of paravalvular leakage (2.2% vs 13.8%), pacemaker implantation (6.6% vs 14.8%), and composite events (7.2% vs 12.7%).
• 3-year survival was higher for MI-SAVR (88%) compared to TF-TAVR (67%) (p<0.001).

Conclusions:

• MI-SAVR with RD valves is a potential treatment for severe AS in older, low-risk patients.
• MI-SAVR demonstrated improved survival and reduced rates of pacemaker implantation and paravalvular leakage.
• This approach may offer advantages over TF-TAVR in specific patient populations.