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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...

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Autores principales: Zubarevich, Alina, Szczechowicz, Marcin, Amanov, Lukman, Arjomandi Rad, Arian, Osswald, Anja, Torabi, Saeed, Ruhparwar, Arjang, Weymann, Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
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.
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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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