Korean J Thorac Cardiovasc Surg.  2017 Aug;50(4):255-262. 10.5090/kjtcs.2017.50.4.255.

Comparison of the Outcomes between Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Replacement in Patients Aged above 80

• Lee JW
• Kim J
• Jung SH
• Chung CH
• Lee JW

• KMID: 2387911
• DOI: http://doi.org/10.5090/kjtcs.2017.50.4.255

Abstract

BACKGROUND
Transcatheter aortic valve replacement (TAVR) has been suggested as a less invasive treatment for high-risk patients with aortic valve disease. In this study, we compared the outcomes of conventional surgical aortic valve replacement (AVR) and TAVR in elderly patients aged over 80.
METHODS
A total of 108 patients aged 80 years or older who underwent isolated AVR (n=35) or TAVR (n=73) from 2010 through 2015 at Asan Medical Center were identified. Early and late clinical outcomes, including echocardiographic findings, were evaluated in both groups. The mean follow-up duration was 766.4±528.7 days in the AVR group and 755.2±546.6 days in the TAVR group, and the average timing of the last follow-up echocardiography was at 492.6±512.5 days in the AVR group and 515.7±526.8 days in the TAVR group.
RESULTS
The overall early mortality was 2.8% (0 of 35, 0% in the AVR group vs. 3 of 73, 4.1% in the TAVR group). Permanent pacemaker insertion was significantly more common in the TAVR group (p=0.010). Renal failure requiring dialysis and new-onset atrial fibrillation was more frequent and the length of hospital stay was longer in the AVR group; however, this difference did not reach statistical significance. In the TAVR group, 14 patients (19.2%) were rehospitalized due to cardiac problems, and 13 patients (17.8%) had developed significant paravalvular leakage by the time of the last follow-up echocardiography.
CONCLUSION
TAVR could be a good alternative to conventional surgical AVR in elderly patients. However, TAVR has several shortcomings, such as frequent significant paravalvular leakage or readmission, which should be considered in decision-making.

Keyword

Aortic valve, surgery; Heart valve disease; Outcomes; Transcatheter aortic valve replacement

MeSH Terms

Aged
Aortic Valve*
Atrial Fibrillation
Chungcheongnam-do
Dialysis
Echocardiography
Follow-Up Studies
Heart Valve Diseases
Humans
Length of Stay
Mortality
Renal Insufficiency
Transcatheter Aortic Valve Replacement*