Transcatheter Aortic Valve Replacement versus Sutureless Aortic Valve Replacement: A Single Center Retrospective Cohort Study
Yonsei Medical Journal 2021³â 62±Ç 10È£ p.885 ~ p.894
Á¤¿µÇÐ(Chung Young-Hak) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
À̽ÂÇö(Lee Seung-Hyun) - Yonsei University College of Medicine Severance Cardiovascular Hospital Department of Thoracic and Cardiovascular Surgery
°í¿µ±¹(Ko Young-Guk) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
ÀÌ»è(Lee Sak) - Yonsei University College of Medicine Severance Cardiovascular Hospital Department of Thoracic and Cardiovascular Surgery
½ÉÁö¿µ(Shim Chi-Young) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
¾Èö¹Î(Ahn Chul-Min) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
È«±×·ç(Hong Geu-Ru) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
½ÉÀ籤(Shim Jae-Kwang) - Yonsei University College of Medicine Severance Cardiovascular Hospital Department of Anesthesiology and Pain Medicine
°û¿µ¶õ(Kwak Young-Lan) - Yonsei University College of Medicine Severance Cardiovascular Hospital Department of Anesthesiology and Pain Medicine
È«¸í±â(Hong Myeong-Ki) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
Abstract
Purpose: This study sought to compare clinical outcomes between transcatheter aortic valve replacement (TAVR) and sutureless aortic valve replacement (SU-AVR).
Materials and Methods: In total, 320 patients with symptomatic severe aortic stenosis who underwent TAVR (n=254) or SU-AVR (n=66) at Severance Cardiovascular Hospital between July 2011 and September 2019 were included for analysis. Propensity score matching and inverse probability weighted adjustment were performed to adjust for confounding baseline characteristics. Outcomes defined by the Valve Academic Research Consortium-2 in 62 patients pairs were compared.
Results: Device success (79.0% vs. 79.0%, p>0.999) and 30-day mortality (4.8% vs. 0.0%, p=0.244) did not differ between the TAVR and SU-AVR groups. The TAVR group developed more frequent mild or moderate paravalvular leakage (59.7% vs. 8.1%, p<0.001), whereas SU-AVR was associated with higher rates of major or life-threatening bleeding (9.7% vs. 22.6%, p=0.040), acute kidney injury (8.1% vs. 21.0%, p=0.041), and new-onset atrial fibrillation (4.8% vs. 32.3%. p<0.001) at 30 days, along with longer stays in the intensive care unit (ICU) (1.9¡¾1.6 days vs. 5.9¡¾9.2 days, p=0.009) and hospital (7.1¡¾7.9 days vs. 13.1¡¾8.8 days, p<0.001). The TAVR group showed a trend towards a higher 1-year all-cause mortality, compared with the SU-AVR group (7.0% vs 1.7%, p=0.149). Cardiovascular mortality, however, did not differ significantly (1.6% vs 1.7%, p=0.960).
Conclusion: TAVR achieved a similar 1-year survival rate free from cardiovascular mortality as SU-AVR and was associated with a lower incidence of complications, except for paravalvular leakage, and shorter stays in the ICU and hospital.
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Aortic stenosis, transcatheter aortic valve replacement, sutureless aortic valve replacement, severe aortic stenosis
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30ÀÏ »ç¸Á·ü TAVR ±×·ì°ú SU-AVR ±×·ì °£¿¡ Â÷ÀÌ°¡ ¾ø¾úÀ¸³ª, TAVRÀº Áõ»óÀÌ ÀÖ´Â ÁßÁõ AS ȯÀÚÀÇ Ä¡·á¿¡ ´õ ¾ÈÀüÇÑ ÀýÂ÷ÀÎ °ÍÀ¸·Î ³ªÅ¸³²[TAVR ±×·ì¿¡¼ ´õ ºó¹øÇÑ °æÁõ, ¶Ç´Â Áߵ ÆǸ·ÁÖÀ§ ´©Ã⠹߻ý(59.7% ´ë 8.1%, p<0.001)ÇÏ¿´À¸³ª, SU-AVRÀº ´õ ³ôÀº ºñÀ²ÀÇ ÁÖ¿ä ¶Ç´Â »ý¸íÀ» À§ÇùÇÏ´Â ÃâÇ÷(9.7% ´ë 22.6%, p= 0.040), 30ÀÏ¿¡ ±Þ¼º ½ÅÀå ¼Õ»ó(8.1% ´ë 21.0%, p=0.041) ¹× »õ·Î ¹ßº´ÇÑ ½É¹æ¼¼µ¿(4.8% ´ë 32.3%. p<0.001), ÁßȯÀڽǿ¡¼ÀÇ Àå±â ü·ù (ICU)(1.9¡¾1.6ÀÏ ´ë 5.9¡¾9.2ÀÏ, p=0.009) ¹× º´¿ø(7.1¡¾7.9ÀÏ ´ë 13.1¡¾8.8ÀÏ, p<0.001) °ü·ÃÀÌ ÀÖÀ½]