Yonsei Med J.  2013 May;54(3):596-602. 10.3349/ymj.2013.54.3.596.

Comparison of Early Clinical Outcomes Following Transcatheter Aortic Valve Implantation versus Surgical Aortic Valve Replacement versus Optimal Medical Therapy in Patients Older than 80 Years with Symptomatic Severe Aortic Stenosis

• Im E
• Hong MK
• Ko YG
• Shin DH
• Kim JS
• Kim BK
• Choi D
• Shim CY
• Chang HJ
• Shim JK
• Kwak YL
• Lee S
• Chang BC
• Jang Y

• KMID: 1727870
• DOI: http://doi.org/10.3349/ymj.2013.54.3.596

Abstract

PURPOSE
Transcatheter aortic valve implantation (TAVI) has become an attractive therapeutic strategy for severe aortic stenosis (AS) in elderly patients due to its minimally-invasive nature. Therefore, early results of its clinical outcomes in elderly Korean patients were evaluated.
MATERIALS AND METHODS
We compared early clinical outcomes of TAVI, surgical aortic valve replacement (SAVR), and optimal medical therapy (OMT) in patients aged > or =80 years with symptomatic severe AS. Treatment groups were allocated as follows: TAVI (n=10), SAVR (n=14), and OMT (n=42).
RESULTS
Baseline clinical characteristics including predicted operative mortality were similar among the three groups. However, patients with New York Heart Association functional class III or IV symptoms and smaller aortic valve area were treated with TAVI or SAVR rather than OMT. In-hospital combined safety endpoints (all-cause mortality, major stroke, peri-procedural myocardial infarction, life-threatening bleeding, major vascular complication, and acute kidney injury) after TAVI or SAVR were significantly lower in the TAVI group than in the SAVR group (10.0% vs. 71.4%, respectively, p=0.005), along with an acceptable rate of symptom improvement and device success. During the follow-up period, the TAVI group showed the lowest rate of 3-month major adverse cardiovascular and cerebrovascular events, a composite of all-cause mortality, myocardial infarction, major stroke, and re-hospitalization (TAVI 0.0% vs. SAVR 50.0% vs. OMT 42.9%, p=0.017).
CONCLUSION
Treatment with TAVI was associated with lower event rates compared to SAVR or OMT. Therefore, TAVI may be considered as the first therapeutic strategy in selected patients aged > or =80 years with symptomatic severe AS.

Keyword

Aortic stenosis; transcatheter aortic valve implantation; treatment outcome

MeSH Terms

Age Factors
Aged, 80 and over
Aortic Valve/*surgery
Aortic Valve Stenosis/diagnosis/*surgery
Female
Humans
Male
Prognosis
Risk Factors
Treatment Outcome

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