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DOI: 10.1055/s-0034-1367340
Transcatheter aortic valve replacement versus conventional aortic valve replacement in patients over 75 years of age - a 5 years single center experience
Objectives: We analysed our data from our transcatheter aortic valve replacement program (TAVR) versus conventional aortic valve replacement (AVR) in patients older than 75 years over the past 5-years.
Methods: From December 2008 up to now, when we started our TAVR program for patients with severe symptomatic aortic stenosis who are at a “high risk” or deemed inoperable, we performed 382 TAVR procedures and 172 AVR procedures in patients over 75 years of age. We retrospectively analysed the preoperative data and the postoperative outcome and follow-up over a period of a maximum of 4.7 years in both groups. The statistical tests were performed by chi-square-test respectively by Student's t-test.
Results: In the TAVR group the patients were significantly older (79.8 ± 3.2 vs. 81.9 ± 5.1 years; p < 0.001) and had a significantly higher logistic Euroscore (21.1 ± 14.1 vs. 18.01 ± 15.3; p < 0.03) than the patients in the AVR group. There was no significant difference in the 30-day mortality (26.7% vs. 18.0%; p = 0.079, n.s.) but over the whole follow up period of a maximum of 4.7 years the mortality after the 30 day-mortality period differs significantly to a higher level of the TAVR group versus the AVR group (18.6% vs. 5.4%; p < 0.001).
Conclusion: Conventional aortic valve replacement in old patients is feasible with an excellent longterm outcome. The TAVR procedure on the other hand enables us to perform aortic valve replacement even in very old and sick patients or in patients deemed inoperable with a comparable perioperative outcome compared to the conventional aortic valve replacement. In the longterm follow the outcome of the AVR group is significantly better at which the comorbidities are one of the main reasons for late mortality in the TAVR group. These patients therefore remain an interdisciplinary challenge.