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Comparison of the long-term outcomes and risk factors of aortic stenosis treatment — in patients undergoing transcatheter aortic valve implantation and surgical aortic valve replacement

Karolina Marzec1, Maria Jaworska-Wilczyńska1, Ilona Kowalik2, Małgorzata Nieznańska1, Adam Witkowski3, Maciej Dąbrowski3, Krzysztof Kuśmierski4, Tomasz Hryniewiecki5
DOI: 10.33963/KP.a2022.0122
·
Pubmed: 35521716
Affiliations
  1. Department of Valvular Heart Disease, National Institute of Cardiology, Warszawa, Poland
  2. Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, Warszawa, Poland
  3. Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
  4. Department of Cardiac Surgery and Transplantation, National Institute of Cardiology, Warszawa, Poland
  5. National Institute of Cardiology, Warszawa, Poland

open access

Online first
Original article
Published online: 2022-05-06

Abstract

BACKGROUND: Aortic stenosis (AS) is the most common valvular heart disease and untreated has bleak prognosis. The only effective method of treatment is valve replacement, surgical (SAVR) or transcatheter (TAVI).

AIMS: We decided to analyze outcomes and predictors of long-term mortality in patients undergoing TAVI and SAVR.

METHODS: A retrospective analysis of 1229 patients with advanced AS, comprising TAVI (n = 211), SAVR (n = 556), SAVR and additional procedures (n = 462) from 2014 to 2018, was performed.

RESULTS: No significant differences between SAVR and TAVI were found for 24-months mortality in groups of consecutive patients. Postoperative stroke or transient ischemic attack (TIA), chronic obstructive pulmonary disease (COPD) and transfusion of red blood cells (RBC) were independent predictors of 1-year mortality after SAVR. Although the above-mentioned factors regarding the increased estimated surgery risk in the EuroScore II (>4%) was predictor of 2-years mortality after SAVR. Risk factors for 6- and 12-months mortality after TAVI were: EuroScore II, new onset of atrial fibrillation (NOAF) and the increased RDW (RBC distribution width). Postoperative respiratory failure was an independent risk factor for 6-, 12- and 24-months mortality in both groups of patients.

CONCLUSIONS: There were no significant differences regarding prognosis after TAVI and SAVR at the 24-month follow-up in propensity score matching model. Independent predictive factors of late mortality after both procedures were EuroScore II and the respiratory failure. Independent predictive factors of late mortality specific for TAVI were NOAF, increased RDW and for SAVR: TIA, stroke, COPD and RBC transfusion.

Abstract

BACKGROUND: Aortic stenosis (AS) is the most common valvular heart disease and untreated has bleak prognosis. The only effective method of treatment is valve replacement, surgical (SAVR) or transcatheter (TAVI).

AIMS: We decided to analyze outcomes and predictors of long-term mortality in patients undergoing TAVI and SAVR.

METHODS: A retrospective analysis of 1229 patients with advanced AS, comprising TAVI (n = 211), SAVR (n = 556), SAVR and additional procedures (n = 462) from 2014 to 2018, was performed.

RESULTS: No significant differences between SAVR and TAVI were found for 24-months mortality in groups of consecutive patients. Postoperative stroke or transient ischemic attack (TIA), chronic obstructive pulmonary disease (COPD) and transfusion of red blood cells (RBC) were independent predictors of 1-year mortality after SAVR. Although the above-mentioned factors regarding the increased estimated surgery risk in the EuroScore II (>4%) was predictor of 2-years mortality after SAVR. Risk factors for 6- and 12-months mortality after TAVI were: EuroScore II, new onset of atrial fibrillation (NOAF) and the increased RDW (RBC distribution width). Postoperative respiratory failure was an independent risk factor for 6-, 12- and 24-months mortality in both groups of patients.

CONCLUSIONS: There were no significant differences regarding prognosis after TAVI and SAVR at the 24-month follow-up in propensity score matching model. Independent predictive factors of late mortality after both procedures were EuroScore II and the respiratory failure. Independent predictive factors of late mortality specific for TAVI were NOAF, increased RDW and for SAVR: TIA, stroke, COPD and RBC transfusion.

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Keywords

aortic stenosis, transcatheter aortic valve implantation, surgical aortic valve replacement, outcomes, risk factors

About this article
Title

Comparison of the long-term outcomes and risk factors of aortic stenosis treatment — in patients undergoing transcatheter aortic valve implantation and surgical aortic valve replacement

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-05-06

Page views

59

Article views/downloads

30

DOI

10.33963/KP.a2022.0122

Pubmed

35521716

Keywords

aortic stenosis
transcatheter aortic valve implantation
surgical aortic valve replacement
outcomes
risk factors

Authors

Karolina Marzec
Maria Jaworska-Wilczyńska
Ilona Kowalik
Małgorzata Nieznańska
Adam Witkowski
Maciej Dąbrowski
Krzysztof Kuśmierski
Tomasz Hryniewiecki

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