Comparison of the Outcomes between Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Replacement in Patients Aged above 80

대한흉부외과학회지 2017년 50권 4호 p.255 ~ p.262

이정우(Lee Jeong-Woo) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
김지훈(Kim Ji-Hoon) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
정성호(Jung Sung-Ho) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
정철현(Chung Cheol-Hyun) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
이재원(Lee Jae-Won) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery

Abstract

Background: Transcatheter aortic valve replacement (TAVR) has been suggested as a less invasive treatment for high-risk patients with aortic valve disease. In this study, we compared the outcomes of conventional surgical aortic valve replacement (AVR) and TAVR in elderly patients aged over 80.

Methods: A total of 108 patients aged 80 years or older who underwent isolated AVR (n=35) or TAVR (n=73) from 2010 through 2015 at Asan Medical Center were identified. Early and late clinical outcomes, including echocardiographic findings, were evaluated in both groups. The mean follow-up duration was 766.4±528.7 days in the AVR group and 755.2±546.6 days in the TAVR group, and the average timing of the last follow-up echocardiography was at 492.6±512.5 days in the AVR group and 515.7±526.8 days in the TAVR group.

Results: The overall early mortality was 2.8% (0 of 35, 0% in the AVR group vs. 3 of 73, 4.1% in the TAVR group). Permanent pacemaker insertion was significantly more common in the TAVR group (p=0.010). Renal failure requiring dialysis and new-onset atrial fibrillation was more frequent and the length of hospital stay was longer in the AVR group; however, this difference did not reach statistical significance. In the TAVR group, 14 patients (19.2%) were rehospitalized due to cardiac problems, and 13 patients (17.8%) had developed significant paravalvular leakage by the time of the last follow-up echocardiography.

Conclusion: TAVR could be a good alternative to conventional surgical AVR in elderly patients. However, TAVR has several shortcomings, such as frequent significant paravalvular leakage or readmission, which should be considered in decision-making.

키워드

Aortic valve, surgery, Heart valve disease, Outcomes, Transcatheter aortic valve replacement
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학술진흥재단(KCI) KoreaMed 대한의학회 회원 
주제코드
주제명(Target field)
연구대상(Population)
연구참여(Sample size)
대상성별(Gender)
질병특성(Condition Category)
연구환경(Setting)
연구설계(Study Design)
연구기간(Period)
중재방법(Intervention Type)
중재명칭(Intervention Name)
키워드(Keyword)
유효성결과(Recomendation)
TAVR could be a good alternative to conventional surgical AVR in elderly patients. However, TAVR has several complications; several complications were more common in the AVR group. Specifically, renal failure requiring dialysis (6 of 35, 17.1% in the AVR group versus 5 of 73, 6.8% in the TAVR group; p=0.098) and new-onset atrial fibrillation (10 of 35, 28.6% in the AVR group versus 11 of 73, 15.1% in the TAVR group; p =0. 097) were more frequent in the AVR group.
연구비지원(Fund Source)
근거수준평가(Evidence Hierarchy)
출판년도(Year)
참여저자수(Authors)
대표저자
DOI
KCD코드
ICD 03
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