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Non-Inferiority of Sutureless Aortic Valve Replacement in the TAVR Era: David versus Goliath
Background: The rapid development of transcatheter treatment methods has made transcatheter aortic valve replacement (TAVR) a feasible alternative to conventional surgical aortic valve replacement (SAVR). Recently, indications for TAVR have been expanded to intermediate- and low-risk patients, altho...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9316623/ https://www.ncbi.nlm.nih.gov/pubmed/35888069 http://dx.doi.org/10.3390/life12070979 |
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author | Zubarevich, Alina Szczechowicz, Marcin Amanov, Lukman Arjomandi Rad, Arian Osswald, Anja Torabi, Saeed Ruhparwar, Arjang Weymann, Alexander |
author_facet | Zubarevich, Alina Szczechowicz, Marcin Amanov, Lukman Arjomandi Rad, Arian Osswald, Anja Torabi, Saeed Ruhparwar, Arjang Weymann, Alexander |
author_sort | Zubarevich, Alina |
collection | PubMed |
description | Background: The rapid development of transcatheter treatment methods has made transcatheter aortic valve replacement (TAVR) a feasible alternative to conventional surgical aortic valve replacement (SAVR). Recently, indications for TAVR have been expanded to intermediate- and low-risk patients, although there still remains a portion of ineligible patients. We sought to evaluate and compare our experience with sutureless SAVR and transapical TAVR in the “grey-area” of patients unsuitable for transfemoral access. Methods: Between April 2018 and June 2021, 248 consecutive patients underwent a sutureless SAVR (SU-SAVR) or TA-TAVR at our institution. We performed a pair-matched analysis and identified 56 patient pairs based on the EuroSCORE II. All transcatheter procedures were performed using SAPIEN XT/3™ prostheses, while all surgical procedures deployed the Perceval (LivaNova) aortic valve. Results: All patients presented with multiple comorbidities as reflected by the median EuroSCORE-II of 3.1% (IQR 1.9–5.3). Thirty-four patients from the surgical group (60.7%) underwent a concomitant myocardial revascularization. There was no significant difference in major adverse events, pacemaker implantation or postoperative mortality during follow-up. Both interventions demonstrated technical success with similar mean postoperative pressure gradients at follow-up and no cases of paravalvular leakage. Conclusions: Sutureless aortic valve replacement constitutes a feasible treatment alternative for patients with aortic valve disease who are ineligible for transfemoral access route and/or require concomitant coronary revascularization. With its excellent hemodynamic performance, similar survival compared to TA-TAVR, and high cost-efficiency without compromising the postoperative outcomes and in-hospital length of stay SU-AVR might be considered for patients in the “grey-area” between TAVR and SAVR. |
format | Online Article Text |
id | pubmed-9316623 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-93166232022-07-27 Non-Inferiority of Sutureless Aortic Valve Replacement in the TAVR Era: David versus Goliath Zubarevich, Alina Szczechowicz, Marcin Amanov, Lukman Arjomandi Rad, Arian Osswald, Anja Torabi, Saeed Ruhparwar, Arjang Weymann, Alexander Life (Basel) Article Background: The rapid development of transcatheter treatment methods has made transcatheter aortic valve replacement (TAVR) a feasible alternative to conventional surgical aortic valve replacement (SAVR). Recently, indications for TAVR have been expanded to intermediate- and low-risk patients, although there still remains a portion of ineligible patients. We sought to evaluate and compare our experience with sutureless SAVR and transapical TAVR in the “grey-area” of patients unsuitable for transfemoral access. Methods: Between April 2018 and June 2021, 248 consecutive patients underwent a sutureless SAVR (SU-SAVR) or TA-TAVR at our institution. We performed a pair-matched analysis and identified 56 patient pairs based on the EuroSCORE II. All transcatheter procedures were performed using SAPIEN XT/3™ prostheses, while all surgical procedures deployed the Perceval (LivaNova) aortic valve. Results: All patients presented with multiple comorbidities as reflected by the median EuroSCORE-II of 3.1% (IQR 1.9–5.3). Thirty-four patients from the surgical group (60.7%) underwent a concomitant myocardial revascularization. There was no significant difference in major adverse events, pacemaker implantation or postoperative mortality during follow-up. Both interventions demonstrated technical success with similar mean postoperative pressure gradients at follow-up and no cases of paravalvular leakage. Conclusions: Sutureless aortic valve replacement constitutes a feasible treatment alternative for patients with aortic valve disease who are ineligible for transfemoral access route and/or require concomitant coronary revascularization. With its excellent hemodynamic performance, similar survival compared to TA-TAVR, and high cost-efficiency without compromising the postoperative outcomes and in-hospital length of stay SU-AVR might be considered for patients in the “grey-area” between TAVR and SAVR. MDPI 2022-06-29 /pmc/articles/PMC9316623/ /pubmed/35888069 http://dx.doi.org/10.3390/life12070979 Text en © 2022 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 Zubarevich, Alina Szczechowicz, Marcin Amanov, Lukman Arjomandi Rad, Arian Osswald, Anja Torabi, Saeed Ruhparwar, Arjang Weymann, Alexander Non-Inferiority of Sutureless Aortic Valve Replacement in the TAVR Era: David versus Goliath |
title | Non-Inferiority of Sutureless Aortic Valve Replacement in the TAVR Era: David versus Goliath |
title_full | Non-Inferiority of Sutureless Aortic Valve Replacement in the TAVR Era: David versus Goliath |
title_fullStr | Non-Inferiority of Sutureless Aortic Valve Replacement in the TAVR Era: David versus Goliath |
title_full_unstemmed | Non-Inferiority of Sutureless Aortic Valve Replacement in the TAVR Era: David versus Goliath |
title_short | Non-Inferiority of Sutureless Aortic Valve Replacement in the TAVR Era: David versus Goliath |
title_sort | non-inferiority of sutureless aortic valve replacement in the tavr era: david versus goliath |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9316623/ https://www.ncbi.nlm.nih.gov/pubmed/35888069 http://dx.doi.org/10.3390/life12070979 |
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