Thorac Cardiovasc Surg 2017; 65(S 01): S1-S110
DOI: 10.1055/s-0037-1598712
Oral Presentations
Sunday, February 12, 2017
DGTHG: Acquired Heart Disease: Rapid Deployment Valves
Georg Thieme Verlag KG Stuttgart · New York

Transfemoral Transcatheter Aortic Valve Implant versus Sutureless Replacement: A Follow-up Study with Matched Populations

G. Santarpino
1   Cardiac Surgery, Klinikum Nürnberg - Paracelsus Medical University Nuremberg, Nürnberg, Germany
,
F. Vogt
1   Cardiac Surgery, Klinikum Nürnberg - Paracelsus Medical University Nuremberg, Nürnberg, Germany
,
S. Pfeiffer
1   Cardiac Surgery, Klinikum Nürnberg - Paracelsus Medical University Nuremberg, Nürnberg, Germany
,
J. Jessl
2   Cardiology, Klinikum Nürnberg - Paracelsus Medical University Nuremberg, Nürnberg, Germany
,
J. Schwab
2   Cardiology, Klinikum Nürnberg - Paracelsus Medical University Nuremberg, Nürnberg, Germany
,
M. Pauschinger
2   Cardiology, Klinikum Nürnberg - Paracelsus Medical University Nuremberg, Nürnberg, Germany
,
T. Fischlein
1   Cardiac Surgery, Klinikum Nürnberg - Paracelsus Medical University Nuremberg, Nürnberg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 February 2017 (online)

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Objectives: The transfemoral transcatheter aortic valve implantation (TF-TAVI) is increasingly performed in patients considered in the “gray zone” between TAVI and surgery. However, the best treatment option in this patient population remains to be established.

Methods: Since 2010, a total of 923 patients underwent TAVI (n = 538) or sutureless aortic valve replacement (AVR) (n = 385). Among these, 79 patients treated with TF-TAVI were compared with 79 propensity score-matched patients who had undergone elective isolated AVR with the sutureless Perceval bioprosthesis ([Table 1]).

Results: In-hospital mortality did not significantly differ between patients who underwent sutureless AVR or TF-TAVI (0 vs. 3 [3.8%]; p = 0.123). Similarly, postoperative complications were comparable between groups. Atrioventricular block requiring postoperative pacemaker implantation occurred in 7 patients (9.2%) of the sutureless group and in 8 patients (11.1%) of the TF-TAVI group (p = 0.455). The use of blood products varied between groups in terms of red blood cell transfusions (1.7 ± 2 vs. 0.3 ± 0.9 units in the sutureless vs. TF-TAVI group, p < 0.001). Paravalvular leakage at discharge was present in 3 patients(3.8%) of the sutureless group and in 26 patients (32.9%) of the TF-TAVI (p < 0.001). Mean follow-up was longer for sutureless AVR(36 ± 21 vs. 27 ± 20 months, p = 0.003). Survival rates were 97.5 and 84.8% in the sutureless vs. TF-TAVI group, respectively (p = 0.001).

Conclusion: Both TF-TAVI and sutureless AVR are well standardized, safe and effective procedures. TF-TAVI seems to be a valuable alternative to surgical AVR for frail patients, reducing the need for perioperative blood transfusion, whereas in patients with a favorable long-term survival outcome, minimally invasive AVR remains the procedure of choice, as it is associated with better long-term results.

Table 1

Variable

Sutureless

TF-TAVI

p Value

Age (years)

78 ± 5

78 ± 8

0.83

Logistic EuroSCORE

15 ± 13

13 ± 8

0.18

Pulmonary hypertension

12 (15)

14 (18)

0.41

Redo

12 (15)

8 (10)

0.24

Poor mobility

15 (19)

9 (11)

0.13

Peripheral arterial disease

3 (4)

5 (6)

0.36

Stroke

3 (4)

4 (5)

0.50

Diabetes on insulin therapy

6 (8)

8 (10)

0.39

Renal insufficiency

20 (25)

27 (34)

0.31