Is transcatheter based aortic valve implantation really less invasive than minimal invasive aortic valve replacement?
Mirko Doss, Sven Martens, Stephan Fichtelscherer, Thomas Trepels, Gerhard Wimmer Greinecker, Anton Moritz, Volker Schächinger; Thoracic and Cardiovascular Surgery, J.W.Goethe University Frankfurt, Frankfurt am Main, Germany
Comment on this Abstract
Objective: Transcatheter valve implants currently draw their justification for use from reduction of perioperative risk. However, patient age and comorbidities are independent predictors of adverse outcome after aortic valve replacement, regardless of prostheses. Therefore, it is unclear, whether in high risk patients, transcatheter based aortic valve implants really improve perioperative outcomes.
Methods: We included a total of 51 high risk patients with severe aortic valve stenosis. Patients were allocated to transcatheter aortic valve implantation, via transapical approach(n=21) or minimal invasive aortic valve replacement, via partial upper sternotomy(n=30), in a non randomized fashion.
Patient age and perioperative risk, expressed as logistic Euroscore, were comparable between the groups (38±14 vs 35±9).
Results: After a mean follow up of 12±4 months, there were 5 deaths(23.8%) in the transcatheter group versus 3 deaths(10%) in the surgery group. Only 2 deaths were procedure related in each group respectively. There was 1 intraoperative death in the transcatheter group versus none in the surgery group. In the transcatheter group, there were 2 rethoracotomies for bleeding, 2 intraoperative conversions, 1 prosthesis migration and 2 impairments of coronaries. In the surgery group, there was 1 rethoracotomy and 3 cases of atrial fibrillation.
There were no cases of endocarditis, stroke or atrio-ventricular block in any of the groups.
Conclusion: Early outcomes after transcatheter aortic valve implantation, in high risk patients, match those of minimal invasive aortic valve surgery.
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