Markov Model for Selection of Aortic Valve Replacement Versus Transcatheter Aortic Valve Implantation (Without Replacement) in High-Risk Patients

2012 ◽  
Vol 109 (9) ◽  
pp. 1326-1333 ◽  
Author(s):  
Hemal Gada ◽  
Samir R. Kapadia ◽  
E. Murat Tuzcu ◽  
Lars G. Svensson ◽  
Thomas H. Marwick
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Markov Model ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
Selection Of

Abstract 2307: Contemporary Perioperative Results of Isolated Aortic Valve Replacement for Aortic Stenosis: Implications for Transcatheter Aortic Valve Implantation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
S C Malaisrie ◽  
Patrick M McCarthy ◽  
Edwin C McGee ◽  
Richard Lee ◽  
Vera Rigolin ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Operative Mortality ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (AVI) is compelling for some high-risk patients with aortic stenosis (AS). However, comparison of procedure outcomes with older surgical series may overestimate operative risk. We therefore analyzed our contemporary series of isolated aortic valve replacement (AVR) for AS. From April 2004 to January 2008, 642 patients underwent AVR with or without concomitant cardiac procedures. Of these patients, 175 patients had an isolated AVR, and 140 patients underwent isolated AVR for AS. The characteristics were age 68, male gender 56%, ejection fraction 57%. Sixty-four percent had a minimally-invasive AVR and 18% were reoperations. Twenty percent were 80 years old or greater, 35% were in NYHA functional class III-IV, and 4% had an estimated operative mortality of 10% or greater using the Society of Thoracic Surgery (STS) risk calculator. Thirty-day mortality was 0%, but there was one in-hospital death (0.7%) from complications of an esophageal perforation. Reoperation for bleeding occurred in 5.7%, cerebrovascular accident (CVA) in 0%, acute renal failure (ARF) in 2.9%, myocardial infarction (MI) in 0%. Bioprosthetic valves were used in 98.6% and mechanical in 1.4%. Mean gradient decreased from 48 mmHg to10 mmHg. Actuarial survival was 97% and 90% at 1 and 3 years. Patients >80 years (n=28) were more likely to have an increased length of hospital stay (9.8 versus 6.3 days, p=0.01) and less likely to be discharged to home (48% versus 86%, p<0.01) as compared to patients <80 years. Today, AVR for AS can be performed in many high-risk patients with low operative mortality and morbidity, although patients over 80 years are at greater risk of prolonged recovery. Transcatheter AVI should be compared to this high threshold.

Three-Year Survival Comparison between Transcatheter and Surgical Aortic Valve Replacement for Intermediate- and Low-Risk Patients

2018 ◽  
Vol 13 (3) ◽  
pp. 153-162 ◽  
Author(s):  
Juan A. Siordia ◽  
Jackquelin M. Loera ◽  
Matt Scanlon ◽  
Jessie Evans ◽  
Peter A. Knight
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Implantation ◽  
Low Risk ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation is a suitable therapeutic intervention for patients deemed inoperable or high risk for surgical aortic valve replacement. Current investigations question whether it is a suitable alternative to surgery for intermediate- and low-risk patients. The following meta-analysis presents a comparison between transcatheter versus surgical aortic valve replacement in patients that are intermediate and low risk for surgery. Articles were collected via an electronic search using Google Scholar and PubMed. Articles of interest included studies comparing the survival of intermediate- and low-risk patients undergoing transcatheter aortic valve implantation to those undergoing surgical aortic valve replacement. Primary end points included 1-, 2-, and 3-year survival. Secondary end points included postintervention thromboembolic events, stroke, transient ischemic attacks, major vascular complications, permanent pacemaker implantation, life-threatening bleeding, acute kidney injury, atrial fibrillation, and moderate-to-severe aortic regurgitation. Six studies met the criteria for the meta-analysis. One- and two-year survival comparisons showed no difference between the two interventions. Surgical aortic valve replacement, however, presented with favorable 3-year survival compared with the transcatheter approach. Transcatheter aortic valve implantation had more major vascular complications, permanent pacemaker implantation, and moderate-to-severe aortic regurgitation rates compared with surgery. Surgical aortic valve replacement presented more life-threatening bleeding, acute kidney injury, and atrial fibrillation compared with a transcatheter approach. There was no statistical difference between the two approaches in terms of thromboembolic events, strokes, or transient ischemic attack rates. Surgical aortic valve replacement presents favorable 3-year survival rates compared with transcatheter aortic valve implantation.

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