Abstract 19309: What is the Impact of Transcatheter Aortic Valve Implantation on Patients' Profile and on Outcomes of Aortic Valve Surgery Programs? A Multi-Institutional Appraisal
Objective: Aim of this retrospective multicenter study was to assess how the introduction of transcatheter aortic valve implantation (TAVI) influenced the characteristics and the outcomes of patients undergoing aortic valve procedures.
Methods: We analyzed data from 1395 patients who underwent isolated surgical aortic valve replacement (SAVR) or TAVI in 3 centers with a high-volume TAVI program. We considered two different time periods: “Pre-TAVI”, 395 patients (28.3%) operated on before the introduction of TAVI and “Post-TAVI”, 1000 patients (71.7%) operated on after the introduction of TAVI into clinical practice. We evaluated patients’ age, preoperative risk stratification (logistic Euroscore) and hospital mortality according to time periods and to the procedure performed.
Results: “Post-TAVI” patients were older (78.2±7.8 vs 76.8±6.7 years; p=0.002) and with a significantly higher risk profile (Logistic Euroscore: 17.8±14.7% vs 9.1±9.2%; p<0.001) when compared to “Pre-TAVI” patients. However, hospital mortality was not significantly different between groups (“Pre-TAVI”: 8 patients, 2% vs “Post-TAVI”: 34 patients, 3.4%; p=0.17). Out of the 1000 “Post-TAVI” period patients, 605 (60.5%) underwent TAVI and 395 (39.5%) underwent SAVR. Patients undergoing TAVI were older (79.9±7.1 vs 75.5±9.2 years; p<0.001) and had a higher Euroscore (22.9±15.3% vs 9.7±9.3%) than “Post-TAVI” SAVR patients but their hospital mortality was similar (24 patients, 3.9% vs 10 patients, 2.5%; p=0.22). Preoperative risk stratification was similar between “Pre-TAVI” and “Post-TAVI” SAVR patients (9.1±9.2% vs 9.7±9.3%; p=0.26). Furthermore, we did not find significant differences in the overall hospital mortality between SAVR and TAVI patients: 18 patients, 2.3% vs 24 patients, 3.9%, p=0.08.
Conclusions: The development of TAVI has determined an increase of preoperative risk profile of patients scheduled for aortic valve procedures (SAVR or TAVI) without increasing hospital mortality. TAVI patients were older and with higher Euroscore than SAVR patients but hospital mortality was similar. Therefore these data justify the introduction of TAVI into routine practice since it allows treatment of high risk patients without an adverse impact on mortality.
- © 2012 by American Heart Association, Inc.