Naslov (eng)

Mortality in low-risk patients with aortic stenosis undergoing transcatheter or surgical aortic valve replacement

Autor

Çelik, Mevlüt
Milojević, Milan
Durko, Andras P.
Oei, Frans B.S.
Bogers, Ad J.J.C.
Mahtab, Edris A.F.

Opis (eng)

OBJECTIVES: Although the standard of care for patients with severe aortic stenosis at low-surgical risk has included surgical aortic valve replacement (SAVR) since the mid-1960s, many clinical studies have investigated whether transcatheter aortic valve implantation (TAVI) can be a better approach in these patients. As no individual study has been performed to detect the difference in mortality between these 2 treatment strategies, we did a reconstructive individual patient data analysis to study the long-term difference in all-cause mortality. METHODS: Randomized clinical trials and propensity score-matched studies that included low-risk adult patients with severe aortic stenosis undergoing either SAVR or TAVI and with reports on the mortality rates during the follow-up period were considered. The primary outcome was all-cause mortality of up to 5 years. RESULTS: In the reconstructed individual patient data analysis, there was no statistically significant difference in all-cause mortality between TAVI and SAVR at 5 years of follow-up [30.7% vs 21.4%, hazard ratio (HR) 1.19, 95% confidence interval (CI) 0.96–1.48; P = 0.104]. However, landmark analyses in patients surviving up to 1 year of follow-up showed significantly higher all-cause mortality at 5 years of follow-up (27.5% vs 17.3%, HR 1.77, 95% CI 1.29–2.43; P < 0.001) in patients undergoing TAVI compared to patients undergoing SAVR, respectively. CONCLUSIONS: This reconstructed individual patient data analysis in low-risk patients with severe aortic stenosis demonstrates that the 5-year all-cause mortality rates are higher after TAVI than after SAVR, driven by markedly higher mortality rates between 1 and 5 years of follow-up in the TAVI group. The present results call for caution in expanding the TAVI procedure as the treatment of choice for the majority of all low-risk patients until long-term data from contemporary randomized clinical trials are available.

Opis (eng)

Appendix: https://unilib.phaidrabg.rs/o:3255

Jezik

engleski

Datum

2020

Licenca

© All rights reserved

Predmet

Key words: surgical aortic valve replacement, trans catheter aortic valve replacement

Deo kolekcije (1)

o:2793

Radovi saradnika Instituta za kardiovaskularne bolesti "Dedinje"