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Updated: Feb 13, 2026

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots

Published on: May 21, 2017

重症大動脈弁狭窄症および左室駆出率低下患者における外科的および経カテーテル大動脈弁置換術の比較：2つの臨床的に選択された集団の傾向スコアマッチング解析

James A Brown¹, Eishan Ashwat¹, Sarah Yousef¹

¹Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA.

Journal of cardiothoracic and vascular anesthesia

|February 11, 2026

要旨

Objective:

To determine the impact of surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis (AS) and reduced ejection fraction (EF).

Design:

A propensity-matched, retrospective study of consecutive aortic valve interventions from 2010 to 2023.

Setting:

A single institution.

Participants:

Patients with severe AS and reduced EF (<50%) undergoing aortic valve intervention.

Interventions:

The cohort was dichotomized by SAVR versus TAVR.

Measurements And Main Results:

A total of 1,164 patients underwent an aortic valve intervention for severe AS with reduced EF (<50%), of which 240 (20.6%) had an isolated SAVR and 924 (79.4%) underwent a TAVR. Propensity matching yielded 205 pairs. The 30-day mortality and stroke rates were no different across groups. Paravalvular leak was significantly higher in the TAVR group, and there was a statistically nonsignificant trend toward more pacemakers in the TAVR group (p = 0.093). At 1 year, EF was similar between groups: 48% (IQR: 41-53) in the SAVR group versus 53% (IQR: 37-58) in the TAVR group (p = 0.431). Conversely, at 1 year, mean pressure gradients were higher in the TAVR group (10 [7-15] mmHg v 8 [7-10] mmHg, p = 0.040). The cumulative incidence of heart failure readmissions was higher in the TAVR group, although it was a statistically nonsignificant trend (p = 0.066). The cumulative incidence of aortic valve reintervention was similar across groups (p = 0.564). Kaplan-Meier survival estimates were significantly lower in the TAVR group (p = 0.016).

Conclusions:

While surgery may optimize survival after aortic valve replacement in patients with reduced EF, these observational findings need to be verified by prospective randomized controlled comparisons.

キーワード:

大動脈弁狭窄症左室駆出率低下外科的大動脈弁置換術経カテーテル大動脈弁置換術

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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Published on: March 26, 2018

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

Published on: December 11, 2017

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