Transcatheter aortic valve implantation versus surgery:4-year survival according to life expectancy
Vittoria Lodo1
Enrico G.Italiano2
Edoardo Zingarelli1
Claudio Pietropaolo3
Stefano Pidello4
Gabriella Buono3
Paolo Centofanti1
1.Department of Cardiac Surgery,Azienda Ospedaliera Ordine Mauriziano di Torino,Turin,Italy2.Department of Cardiac Surgery,University of Padova,Padua,Italy3.Department of Cardiovascular Anesthesia and Intensive Care,Azienda Ospedaliera Ordine Mauriziano,Turin,Italy4.Department of Cardioloy,Città della Salute e della Scienza Hospital,Turin,Italy
摘要：Background In the last years,transcatheter aortic valve implantation(TAVI)indication has expanded to younger and lower risk patients.Consequently,interest in mid and long-term follow up and in the role of life expectancy,as a key factor for select-ing the most tailored treatment,has grown.The aim of this retrospective study is to compare the 4-year survival of patients who underwent aortic valve replacement(AVR)vs.TAVI at our department.
Methods From September 2017 to December 2020,673 consecutive patients with severe aortic valve stenosis were enrolled for AVR(n=283)or TAVI(n=390).Inclusion criteria was isolated severe aortic stenosis,while exclusion criteria were redo surgery,valve-in-valve procedure and the need for concomitant surgical procedures.Based on the Lee index,patients were divided into four groups according to their 4-year life expectancy.Four-year survival was assessed and reported using the Kaplan-Meier method.A multivariate regression analysis of risk factors for 4-year mortality was performed.
Results Four years survival is always superior in the AVR patients(89.8％vs.75.6％,P＜0.001).Surgery is associated with a higher incidence of acute kidney injury(23％vs.5.1％,P＜0.001),while TAVI is related to a higher incidence of new onset left bundle branch block(0 vs.23.8％,P＜0.001),pace-maker implantation(2.5％vs.11.8％,P=0,02)and mild-to-moderate paravalvu-lar leak(0.3％vs.5.4％,P＜0.001).The independent risk factors for 4-years mortality are post-procedural AKI,poor mobility and transcatheter procedure.
Conclusion In our analysis,4 years survival is always superior in the AVR patients.Life expectancy is a key factor for selecting the most appropriate approach for each patient.A longer follow up is mandatory before extending TAVI indication to patients with a long-life expectancy.
机标关键词：surgerylife4-yearaccordingaorticexpectancyimplantationsurvival
论文发表日期：2024-09-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：9( 846-854 )