Thirty-day outcome after transcatheter aortic valve implantation compared with surgical valve replacement in patients with high-risk aortic stenosis: a matched comparison.

Background Transcatheter aortic valve implantation (TAVI) has become a therapeutic alternative to surgery for the treatment of severe aortic stenosis in high-surgical risk patients. The aim of this study was to compare 30-day mortality of high-risk patients treated by TAVI versus surgical aortic valve replacement. Methods A total of 175 patients (60 men; mean age, 80 +/- 6 years; Euroscore 21 +/- 13%) having undergone TAVI were compared with 175 matched patients (76 men; mean age, 79 +/- 3 years; Euroscore 17 +/- 9%), which have undergone conventional aortic valve replacement and were deemed to be high-risk patients by the cardiothoracic surgeons. Thirty-day mortality and major adverse events were recorded in both groups. Patients' characteristics were analyzed for predictors of mortality in the TAVI group. Results Twenty-one patients (12%) in the TAVI group and 13 patients (8%) in the surgical group died within 30 days of the procedure (P = 0.165). Two patients (1%) in the TAVI group and one patient (0.5%) in the conventional surgery group had a major stroke (P = 1.0). Seven patients (4%) in the TAVI group and 25 patients (14%) in the conventional surgery group required dialysis post procedure (P = 0.0013). The average length of stay in the intensive care unit was lower in the TAVI group compared with the conventional surgical group (3.3 +/- 3.1 vs. 6.6 +/- 10.5 days; P < 0.001). Age was the only independent predictor of mortality in the TAVI group (odds ratio = 1.009; 95% confidence interval: 1.001-1.018 per additional year; P = 0.0186) and in the total study population (odds ratio = 1.007; 95% confidence interval: 1.001-1.013 per additional year; P = 0.0186). Conclusion In high-surgical risk patients, TAVI can be performed at a mortality risk comparable with conventional surgery with a reduced length of post interventional intensive care unit stay and less need for dialysis. Coron Artery Dis 22: 595-600 (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.