TY - JOUR
T1 - A 3-center comparison of 1-year mortality outcomes between transcatheter aortic valve implantation and surgical aortic valve replacement on the basis of propensity score matching among intermediate-risk surgical patients
AU - Piazza, Nicolo
AU - Kalesan, Bindu
AU - Van Mieghem, Nicolas
AU - Head, Stuart
AU - Wenaweser, Peter
AU - Carrel, Thierry P.
AU - Bleiziffer, Sabine
AU - De Jaegere, Peter P.
AU - Gahl, Brigitta
AU - Anderson, Robert H.
AU - Kappetein, Arie Pieter
AU - Lange, Ruediger
AU - Serruys, Patrick W.
AU - Windecker, Stephan
AU - Jüni, Peter
N1 - Funding Information:
Dr. Piazza has served as consultant for Medtronic, HighLife, and CardiaAQ; and steering committee member for the SURTAVI trial. Dr. van Mieghem has served as study chair and steering committee member for the SURTAVI trial. Dr. Wenaweser has served as proctor for Medtronic and Edwards Lifesciences; is a consultant for Biotronik; has received honoraria/lecture fees from Medtronic and Edwards Lifesciences; and has received honoraria from Biotronik. Dr. Bleiziffer has served as consultant for Medtronic and Edwards Lifesciences; and as a proctor for Medtronic and JenaValve. Dr. de Jaegere has served as consultant for Medtronic. Dr. Kappetein has served as principal investigator for the SURTAVI trial. Dr. Lange has served on the advisory board and as consultant for Medtronic; and principal investigator for the SURTAVI trial. Dr. Serruys has served as Study Chair for the SURTAVI trial. Dr. Windecker has served as principal investigator for the SURTAVI trial; been supported by grants to the institution from Medtronic , Edwards Lifesciences , Abbott , Cordis , Biotronik , Boston Scientific , Biosensors , and St. Jude ; and has received lecture fees from Edwards Lifesciences and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Dr. Piazza and Dr. Kalesan contributed equally to this work.
PY - 2013/5
Y1 - 2013/5
N2 - Objectives: This study sought to compare all-cause mortality in patients at intermediate surgical risk undergoing transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). Background: Physicians are selecting "lower" surgical risk patients to undergo TAVI. No clinical data exist about the clinical outcomes of TAVI versus SAVR among intermediate-surgical-risk patients. Methods: We prospectively enrolled symptomatic patients with severe aortic stenosis who underwent TAVI or SAVR. Propensity-score matched pairs of TAVI and SAVR patients with Society of Thoracic Surgeons (STS) scores between 3% and 8% made up the study population. Primary endpoint was all-cause mortality at 1 year. Results: Between November 2006 and January 2010, 3,666 consecutive patients underwent either TAVI (n = 782) or SAVR (n = 2,884). Four hundred five TAVI patients were matched to 405 SAVR patients. Of matched TAVI patients, 99 (24%) patients had STS scores <3%, 255 (63%) had scores between 3% and 8%, and 51 (13%) had scores >8%. Among patients with STS scores between 3% and 8%, 20 (7.8%) versus 18 (7.1%) patients had died up to 30 days (hazard ratio: 1.12, 95% confidence interval: 0.58 to 2.15, p = 0.74) and 42 (16.5%) versus 43 (16.9%) patients had died up to 1 year (hazard ratio: 0.90, 95% confidence interval: 0.57 to 1.42, p = 0.64) after TAVI and SAVR, respectively. Effects of treatment on 1-year mortality were similar across all subgroups except for sex, with some evidence for a beneficial effect of TAVI in women but not in men (test for interaction p = 0.024). Conclusions: Cumulative all-cause mortality at 30 days and 1 year was similar among propensity-score matched TAVI and SAVR patients at intermediate surgical risk. (Surgical Replacement and Transcatheter Aortic Valve Implantation [SURTAVI]; NCT01586910)
AB - Objectives: This study sought to compare all-cause mortality in patients at intermediate surgical risk undergoing transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). Background: Physicians are selecting "lower" surgical risk patients to undergo TAVI. No clinical data exist about the clinical outcomes of TAVI versus SAVR among intermediate-surgical-risk patients. Methods: We prospectively enrolled symptomatic patients with severe aortic stenosis who underwent TAVI or SAVR. Propensity-score matched pairs of TAVI and SAVR patients with Society of Thoracic Surgeons (STS) scores between 3% and 8% made up the study population. Primary endpoint was all-cause mortality at 1 year. Results: Between November 2006 and January 2010, 3,666 consecutive patients underwent either TAVI (n = 782) or SAVR (n = 2,884). Four hundred five TAVI patients were matched to 405 SAVR patients. Of matched TAVI patients, 99 (24%) patients had STS scores <3%, 255 (63%) had scores between 3% and 8%, and 51 (13%) had scores >8%. Among patients with STS scores between 3% and 8%, 20 (7.8%) versus 18 (7.1%) patients had died up to 30 days (hazard ratio: 1.12, 95% confidence interval: 0.58 to 2.15, p = 0.74) and 42 (16.5%) versus 43 (16.9%) patients had died up to 1 year (hazard ratio: 0.90, 95% confidence interval: 0.57 to 1.42, p = 0.64) after TAVI and SAVR, respectively. Effects of treatment on 1-year mortality were similar across all subgroups except for sex, with some evidence for a beneficial effect of TAVI in women but not in men (test for interaction p = 0.024). Conclusions: Cumulative all-cause mortality at 30 days and 1 year was similar among propensity-score matched TAVI and SAVR patients at intermediate surgical risk. (Surgical Replacement and Transcatheter Aortic Valve Implantation [SURTAVI]; NCT01586910)
KW - SAVR
KW - SURTAVI
KW - TAVI
KW - aortic stenosis
KW - intermediate surgical risk
KW - surgical aortic valve replacement
KW - transcatheter aortic valve implantation
KW - transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=84877951487&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2013.01.136
DO - 10.1016/j.jcin.2013.01.136
M3 - Article
C2 - 23702009
AN - SCOPUS:84877951487
SN - 1936-8798
VL - 6
SP - 443
EP - 451
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 5
ER -