Comparison of the Outcomes between Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Replacement in Patients Aged above 80
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ÀÌÁ¤¿ì(Lee Jeong-Woo) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
±èÁöÈÆ(Kim Ji-Hoon) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
Á¤¼ºÈ£(Jung Sung-Ho) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
Á¤Ã¶Çö(Chung Cheol-Hyun) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
ÀÌÀç¿ø(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¡¾528.7 days in the AVR group and 755.2¡¾546.6 days in the TAVR group, and the average timing of the last follow-up echocardiography was at 492.6¡¾512.5 days in the AVR group and 515.7¡¾526.8 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.
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Aortic valve, surgery, Heart valve disease, Outcomes, Transcatheter aortic valve replacement
KMID :
0364020170500040255
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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.