TAVR vs. the Least Invasive Surgically Implanted Valve

Rapid-deployment surgically implanted valves are designed to make a surgeons’ job faster and easier, compared with conventional bioprostheses, which require several stitches. These valves, which shorten surgical times, could compete with transcatheter-implanted valves (transcatheter aortic valve replacement, TAVR).

TAVI vs la válvula quirúrgica menos invasiva

The German Aortic Valve Registry analyzed 16,473 patients who underwent surgical aortic valve replacement with either a current-generation rapid-release valve or current-generation TAVR between 2011 and 2017.

Results from both procedures and devices were compared after matching patients 1:1 using propensity score.

TAVR patients were older and had higher surgical risk scores than those who underwent surgery.

Patients who underwent surgical valve replacement with rapid-release valves suffered from more disabling stroke (1.7% vs. 1.1%; p = 0.03) and needed more transfusions (8.5% vs. 1.4%; p < 0.001) and dialysis (1.9% vs. 1.2%; p = 0.01). Besides that, they had lower pacemaker implantation rates than their TAVR counterparts (8.4% vs. 14.9%; p < 0.001). 

In-hospital mortality was similar (1.6% vs. 1.8%; p = 0.62) when analyzing raw data, but after propensity score matching, a significant advantage in favor of TAVR was found (1.7% vs. 0.6%; p = 0.003).


Read also: The Best Anticoagulant Agent for AF After TAVR.


Balloon-expandable rapid-release valves had lower residual gradients than balloon-expandable TAVR. The opposite was observed with self-expanding valves, with which rapid-release valves had higher gradients.

Conclusion

This large registry of patients with aortic stenosis showed that TAVR presents an advantage in terms of in-hospital mortality compared with surgery using rapid-release valves. Rapid-release surgically implanted valves were better than percutaneous valves only in terms of pacemaker implantation.

Hemodynamic results varied according to the release mechanism of the device.

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Título original: Transcatheter Versus Rapid-Deployment Aortic Valve Replacement. A Propensity-Matched Analysis From the German Aortic Valve Registry.

Referencia: Mohamed Abdel-Wahab et al. J Am Coll Cardiol Intv 2020;13:2642–54. https://doi.org/10.1016/j.jcin.2020.09.018.


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