Abstract:
OBJECTIVES:Although the use of transcatheter aortic valve replacement (TAVR) has recently become an attractive strategy in extremely high-risk patients undergoing aortic valve replacement (AVR), the most appropriate treatment option in patients with an intermediate- to high-risk profile with conventional surgery (sAVR), TAVR or novel options, such as sutureless valves, has been widely debated. METHODS:One hundred and sixty-three consecutive patients with intermediate to high risk were prospectively enrolled and selected to undergo sAVR (Group 1: G1, n = 55), sutureless valve implantation (Group 2: G2, n = 53) or TAVR (Group 3: G3, n = 55) following a multidisciplinary evaluation including frailty, anatomy and degree of atherosclerotic disease of the aorta/peripheral vessels. The mean logistic EuroSCORE (G1 = 21.3 ± 12.7 vs G2 = 16 ± 11.7 vs G3 = 20.4 ± 12.7, P = 0.06) and preoperative demographics, such as age, gender and left ventricular ejection fraction, were similar: of note, chronic obstructive pulmonary disease was more frequent in TAVI patients (G1 = 27.2% vs G2 = 15.1% vs G3 = 47%; P <0.01). The Perceval S sutureless valve was used in Group 2, whereas TAVR was performed with a Corevalve prosthesis. RESULTS:Post-procedural pacemaker implantation (G1 = 1.8% vs G2 = 2% vs G3 = 25.5%, P <0.001) and peripheral vascular complications (G1 = 0% vs G2 = 0% vs G3 = 14.5%, P <0.001) occurred more frequently in patients undergoing TAVR. Hospital mortality was similar among the groups (G1 = 0% vs G2 = 0% vs G3 = 1.8%, P = NS). At the 24-month follow-up, overall survival free from major adverse cardiac and cerebrovascular events and prosthetic regurgitation was better in patients who had undergone sAVR and sutureless valves than those who had undergone TAVR (G1 = 95.2 ± 3.3% vs G2 = 91.6 ± 3.8% vs G3 = 70.5 ± 7.6%; P = 0.015). CONCLUSIONS:This preliminary study suggests that the use of TAVR in patients with an intermediate- to high-risk profile is associated with a higher rate of perioperative complications and decreased survival at the 24-month follow-up compared with the use of conventional surgery or sutureless valves.
journal_name
Interact Cardiovasc Thorac Surgjournal_title
Interactive cardiovascular and thoracic surgeryauthors
Muneretto C,Bisleri G,Moggi A,Di Bacco L,Tespili M,Repossini A,Rambaldini Mdoi
10.1093/icvts/ivu340subject
Has Abstractpub_date
2015-01-01 00:00:00pages
90-5issue
1eissn
1569-9293issn
1569-9285pii
ivu340journal_volume
20pub_type
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journal_title:Interactive cardiovascular and thoracic surgery
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journal_title:Interactive cardiovascular and thoracic surgery
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doi:10.1093/icvts/ivw009
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journal_title:Interactive cardiovascular and thoracic surgery
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doi:10.1510/icvts.2009.211755
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journal_title:Interactive cardiovascular and thoracic surgery
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doi:10.1093/icvts/ivr082
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pub_type: 杂志文章,多中心研究
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journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
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doi:10.1510/icvts.2010.261164
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pub_type: 杂志文章
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journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
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pub_type: 杂志文章,评审
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journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章,评审
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journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2008.197434
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doi:10.1093/icvts/ivr101
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journal_title:Interactive cardiovascular and thoracic surgery
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doi:10.1510/icvts.2011.272120
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pub_type: 杂志文章,评审
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更新日期:2019-04-01 00:00:00
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journal_title:Interactive cardiovascular and thoracic surgery
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doi:10.1510/icvts.2009.210518
更新日期:2009-11-01 00:00:00
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