TAVR or Surgery for Intermediate-Risk Patients? (GARY Registry)

New findings from the GARY (German Aortic Valve Registry) registry show that intermediate-risk patients with severe aortic stenosis presented significantly higher mortality at 1 year when treated with transcatheter aortic valve replacement (TAVR) rather than with conventional surgery.

 

Results reflect everyday realities, which might include various bias tipping the scales towards one strategy or the other, and which could have contributed to the results.

 

The survival difference favoring surgery shown in the registry persisted even after propensity-score matching, but that does not rule out the presence of many other unadjusted confounding variables.

 

Almost 50,000 patients were enrolled in the GARY registry between January 2011 and December 2013, of whom 22.7% presented intermediate surgical risk (logistic EuroSCORE 10-20%).

 

Overall, 5997 patients who underwent TAVR or isolated valve surgery were included in the analysis.

 

Baseline differences between groups were striking, since patients who underwent TAVR showed higher surgical risk, presented greater age, worse heart failure, more prior myocardial infarction, more atrial fibrillation The most frequent reasons underlying the choice of TAVR over surgery were patient age and frailty.

 

Many of these factors might have affected the rate of all-cause mortality at a year: 8.9% for surgery vs. 16.6% for TAVR (p < 0.001).

 

The decision to choose one strategy over the other was made by a heart team in over 90% of patients, and it is clearly impossible to adjust for medical opinion.

 

Original title: Patients at Intermediate Surgical Risk Undergoing Isolated Interventional or Surgical Aortic Valve Replacement for Severe Symptomatic Aortic Valve Stenosis.

Presenter: Werner N.


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