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Sutureless Aortic Valve Replacement vs. Transcatheter Aortic Valve Implantation in Patients with Small Aortic Annulus: Clinical and Hemodynamic Outcomes from a Multi-Institutional Study.
Bacco, Lorenzo Di; D'Alonzo, Michele; Eusanio, Marco Di; Rosati, Fabrizio; Solinas, Marco; Baudo, Massimo; Folliguet, Thierry; Benussi, Stefano; Fischlein, Theodor; Muneretto, Claudio.
Afiliação
  • Bacco LD; Department of Cardiac Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
  • D'Alonzo M; Department of Cardiac Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
  • Eusanio MD; Cardiovascular Surgery Department, Ospedali Riuniti, Ancona, Italy.
  • Rosati F; Department of Cardiac Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
  • Solinas M; Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Massa, Italy.
  • Baudo M; Department of Cardiac Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
  • Folliguet T; Cardiac surgery, Centre Hospitalier Universitaire Mondor, Créteil, France.
  • Benussi S; Department of Cardiac Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
  • Fischlein T; Department of Cardiac Surgery, Klinikum Nürnberg, Nuremberg, Germany.
  • Muneretto C; Department of Cardiac Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
Braz J Cardiovasc Surg ; 39(4): e20230155, 2024 Jul 22.
Article em En | MEDLINE | ID: mdl-39038084
ABSTRACT

OBJECTIVE:

This study aimed to compare hemodynamic performances and clinical outcomes of patients with small aortic annulus (SAA) who underwent aortic valve replacement by means of sutureless aortic valve replacement (SUAVR) or transcatheter aortic valve implantation (TAVI).

METHODS:

From 2015 to 2020, 622 consecutive patients with SAA underwent either SUAVR or TAVI. Through a 11 propensity score matching analysis, two homogeneous groups of 146 patients were formed. Primary endpoint all cause-death at 36 months. Secondary endpoints incidence of moderate to severe patient-prosthesis mismatch (PPM) and incidence of major adverse cardiovascular and cerebrovascular events (MACCEs).

RESULTS:

All-cause death at three years was higher in the TAVI group (SUAVR 12.2% vs. TAVI 21.0%, P=0.058). Perioperatively, comparable hemodynamic performances were recorded in terms of indexed effective orifice area (SUAVR 1.12 ± 0.23 cm2/m2 vs. TAVI 1.17 ± 0.28 cm2/m2, P=0.265), mean transvalvular gradients (SUAVR 12.9 ± 5.3 mmHg vs. TAVI 12.2 ± 6.2 mmHg, P=0.332), and moderate-to-severe PPM (SUAVR 4.1% vs. TAVI 8.9%, P=0.096). TAVI group showed a higher cumulative incidence of MACCEs at 36 months (SUAVR 18.1% vs. TAVI 32.6%, P<0.001). Pacemaker implantation (PMI) and perivalvular leak ≥ 2 were significantly higher in TAVI group and identified as independent predictors of mortality (PMI hazard ratio [HR] 3.05, 95% confidence interval [CI] 1.34-6.94, P=0.008; PPM HR 2.72, 95% CI 1.25-5.94, P=0.012).

CONCLUSION:

In patients with SAA, SUAVR and TAVI showed comparable hemodynamic performances. Moreover, all-cause death and incidence of MACCEs at follow-up were significantly higher in TAVI group.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Valva Aórtica / Estenose da Valva Aórtica / Pontuação de Propensão / Substituição da Valva Aórtica Transcateter / Hemodinâmica Limite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: Braz J Cardiovasc Surg Assunto da revista: ANGIOLOGIA / CARDIOLOGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Itália País de publicação: Brasil
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Valva Aórtica / Estenose da Valva Aórtica / Pontuação de Propensão / Substituição da Valva Aórtica Transcateter / Hemodinâmica Limite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: Braz J Cardiovasc Surg Assunto da revista: ANGIOLOGIA / CARDIOLOGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Itália País de publicação: Brasil