Comparison of Early Clinical Results of Transcatheter versus Surgical Aortic Valve Replacement in Symptomatic High Risk Severe Aortic Stenosis Patients
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À¯¿ì½Ä(Yu Woo-Sik) - Yonsei University College of Medicine Department of Thoracic and Cardiovascular Surgery
À庴ö(Chang Byung-Chul) - Yonsei University College of Medicine Department of Thoracic and Cardiovascular Surgery
ÁÖÇöö(Joo Hyun-Chel) - Yonsei University College of Medicine Department of Thoracic and Cardiovascular Surgery
°í¿µ±¹(Ko Young-Guk) - Yonsei University College of Medicine Department of Cardiology
ÀÌ»è(Lee Sak) - Yonsei University College of Medicine Department of Thoracic and Cardiovascular Surgery
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has been an alternative to conventional aortic valve re-placement (AVR) in old and high risk patients. The goal of this study is to compare the early outcomes of con-ventional AVR vs. TAVI in high risk severe AS patients.
Methods: From January 2008 to July 2012, 44 high risk severe aortic stenosis patients underwent conventional AVR, and 15 patients underwent TAVI. We compared echo-cardiographic data, periprocedural complication, and survival. The mean follow-up duration was 14.5¡¾10 months (AVR), and 6.8¡¾3.5 months (TAVI), respectively.
Results: AVR group was younger (78.2¡¾2.4 years vs. 82.2¡¾3.0 years, p£¼0.001) and had lower operative risk (Euroscore: 9.4¡¾2.7 vs. 11.0¡¾2.0, p=0.044) than TAVI group. There was no significant difference in early mortality (11.4% vs. 13.3%, p=0.839), and 1 year survival (87.4%¡¾5.3% vs. 83.1%¡¾1.1%, p=0.805). There was no significant difference in postoperative functional class. There was no sig-nificant difference in periprocedural complication except vascular complication (0% [AVR] vs. 13.3% [TAVI], p=0.014). TAVI group had more moderate and severe paravalvular leakage.
Conclusion: In this study, both groups had sim-ilar periprocedural morbidity, and mortality. However, TAVI group had more greater than moderate paravalvular leak-age, which can influence long-term outcome. Since more patients are treated with TAVI even in moderate risk, careful selection of the patients and appropriate guideline need to be established.
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Aortic valve stenosis, Aortic valve, surgery, Transcatheter aortic valve implantation
KMID :
0364020130460050346
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In this study, the TAVI group had a similar 1-year survival to the AVR group despite the fact that TAVI was performed in older and higher risk patients; AVR group was younger (78.2¡¾2.4 years vs. 82.2¡¾3.0 years, p£¼0.001) and had lower operative risk (Euroscore: 9.4¡¾2.7 vs. 11.0¡¾2.0, p=0.044) than TAVI group. There was no significant difference in early mortality (11.4% vs. 13.3%, p=0.839), and 1 year survival (87.4%¡¾5.3% vs. 83.1%¡¾1.1%, p=0.805).