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Transcatheter versus Isolated Surgical Aortic Valve Replacement in Young High-Risk Patients: A Propensity Score-Matched Analysis

Background: Younger patients with severe symptomatic aortic stenosis are a particularly challenging collective with regard to the choice of intervention. High-risk patients younger than 75 years of age are often eligible for both the transcatheter aortic valve replacement (TAVR) and the isolated sur...

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Autores principales: Mach, Markus, Poschner, Thomas, Hasan, Waseem, Kerbel, Tillmann, Szalkiewicz, Philipp, Hasimbegovic, Ena, Andreas, Martin, Gross, Christoph, Strouhal, Andreas, Delle-Karth, Georg, Grabenwöger, Martin, Adlbrecht, Christopher, Schober, Andreas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8346998/
https://www.ncbi.nlm.nih.gov/pubmed/34362230
http://dx.doi.org/10.3390/jcm10153447
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author Mach, Markus
Poschner, Thomas
Hasan, Waseem
Kerbel, Tillmann
Szalkiewicz, Philipp
Hasimbegovic, Ena
Andreas, Martin
Gross, Christoph
Strouhal, Andreas
Delle-Karth, Georg
Grabenwöger, Martin
Adlbrecht, Christopher
Schober, Andreas
author_facet Mach, Markus
Poschner, Thomas
Hasan, Waseem
Kerbel, Tillmann
Szalkiewicz, Philipp
Hasimbegovic, Ena
Andreas, Martin
Gross, Christoph
Strouhal, Andreas
Delle-Karth, Georg
Grabenwöger, Martin
Adlbrecht, Christopher
Schober, Andreas
author_sort Mach, Markus
collection PubMed
description Background: Younger patients with severe symptomatic aortic stenosis are a particularly challenging collective with regard to the choice of intervention. High-risk patients younger than 75 years of age are often eligible for both the transcatheter aortic valve replacement (TAVR) and the isolated surgical aortic valve replacement (iSAVR). Data on the outcomes of both interventions in this set of patients are scarce. Methods: One hundred and forty-four propensity score-matched patients aged 75 years or less who underwent TAVR or iSAVR at the Hietzing Heart Center in Vienna, Austria, were included in the study. The mean age was 68.9 years (TAVR 68.7 vs. SAVR 67.6 years; p = 0.190) and the average EuroSCORE II was 5.4% (TAVR 4.3 [3.2%] vs. iSAVR 6.4 (4.3%); p = 0.194). Results: Postprocedural adverse event data showed higher rates of newly acquired atrial fibrillation (6.9% vs. 19.4%; p = 0.049), prolonged ventilation (2.8% vs. 25.0%; p < 0.001) and multi-organ failure (0% vs. 6.9%) in the surgical cohort. The in-hospital and 30-day mortality was significantly higher for iSAVR (1.4% vs. 13.9%; p = 0.012; 12.5% vs. 2.8%; p = 0.009, respectively). The long-term survival (median follow-up 5.0 years (2.2–14.1 years)) of patients treated with the surgical approach was superior to that of patients undergoing TAVR (p < 0.001). Conclusion: Although the survival analysis revealed a higher in-hospital and 30-day survival rate for high-risk patients aged ≤75 years who underwent TAVR, iSAVR was associated with a significantly higher long-term survival rate.
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spelling pubmed-83469982021-08-08 Transcatheter versus Isolated Surgical Aortic Valve Replacement in Young High-Risk Patients: A Propensity Score-Matched Analysis Mach, Markus Poschner, Thomas Hasan, Waseem Kerbel, Tillmann Szalkiewicz, Philipp Hasimbegovic, Ena Andreas, Martin Gross, Christoph Strouhal, Andreas Delle-Karth, Georg Grabenwöger, Martin Adlbrecht, Christopher Schober, Andreas J Clin Med Article Background: Younger patients with severe symptomatic aortic stenosis are a particularly challenging collective with regard to the choice of intervention. High-risk patients younger than 75 years of age are often eligible for both the transcatheter aortic valve replacement (TAVR) and the isolated surgical aortic valve replacement (iSAVR). Data on the outcomes of both interventions in this set of patients are scarce. Methods: One hundred and forty-four propensity score-matched patients aged 75 years or less who underwent TAVR or iSAVR at the Hietzing Heart Center in Vienna, Austria, were included in the study. The mean age was 68.9 years (TAVR 68.7 vs. SAVR 67.6 years; p = 0.190) and the average EuroSCORE II was 5.4% (TAVR 4.3 [3.2%] vs. iSAVR 6.4 (4.3%); p = 0.194). Results: Postprocedural adverse event data showed higher rates of newly acquired atrial fibrillation (6.9% vs. 19.4%; p = 0.049), prolonged ventilation (2.8% vs. 25.0%; p < 0.001) and multi-organ failure (0% vs. 6.9%) in the surgical cohort. The in-hospital and 30-day mortality was significantly higher for iSAVR (1.4% vs. 13.9%; p = 0.012; 12.5% vs. 2.8%; p = 0.009, respectively). The long-term survival (median follow-up 5.0 years (2.2–14.1 years)) of patients treated with the surgical approach was superior to that of patients undergoing TAVR (p < 0.001). Conclusion: Although the survival analysis revealed a higher in-hospital and 30-day survival rate for high-risk patients aged ≤75 years who underwent TAVR, iSAVR was associated with a significantly higher long-term survival rate. MDPI 2021-08-03 /pmc/articles/PMC8346998/ /pubmed/34362230 http://dx.doi.org/10.3390/jcm10153447 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Mach, Markus
Poschner, Thomas
Hasan, Waseem
Kerbel, Tillmann
Szalkiewicz, Philipp
Hasimbegovic, Ena
Andreas, Martin
Gross, Christoph
Strouhal, Andreas
Delle-Karth, Georg
Grabenwöger, Martin
Adlbrecht, Christopher
Schober, Andreas
Transcatheter versus Isolated Surgical Aortic Valve Replacement in Young High-Risk Patients: A Propensity Score-Matched Analysis
title Transcatheter versus Isolated Surgical Aortic Valve Replacement in Young High-Risk Patients: A Propensity Score-Matched Analysis
title_full Transcatheter versus Isolated Surgical Aortic Valve Replacement in Young High-Risk Patients: A Propensity Score-Matched Analysis
title_fullStr Transcatheter versus Isolated Surgical Aortic Valve Replacement in Young High-Risk Patients: A Propensity Score-Matched Analysis
title_full_unstemmed Transcatheter versus Isolated Surgical Aortic Valve Replacement in Young High-Risk Patients: A Propensity Score-Matched Analysis
title_short Transcatheter versus Isolated Surgical Aortic Valve Replacement in Young High-Risk Patients: A Propensity Score-Matched Analysis
title_sort transcatheter versus isolated surgical aortic valve replacement in young high-risk patients: a propensity score-matched analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8346998/
https://www.ncbi.nlm.nih.gov/pubmed/34362230
http://dx.doi.org/10.3390/jcm10153447
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