Thorac Cardiovasc Surg 2017; 65(03): 212-217
DOI: 10.1055/s-0036-1586491
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Conventional versus Transapical Aortic Valve Replacement: Is It Time for Shift in Indications?

Hardy Baumbach
1  Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany
,
Samir Ahad
1  Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany
,
Christian Rustenbach
1  Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany
,
Stephan Hill
2  Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
,
Tim Schäufele
2  Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
,
Kristina Wachter
1  Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany
,
Ulrich Friedrich Wilhelm Franke
1  Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany
› Author Affiliations
Further Information

Publication History

18 February 2016

24 June 2016

Publication Date:
12 August 2016 (online)

Abstract

Background The incidence of degenerative aortic valve diseases has increased along with the life expectancy of our population. Although conventional aortic valve replacement (AVR) is the gold standard for symptomatic aortic stenosis, transcatheter procedures have proven to be a valid therapeutic option in high-risk patients. The aim of this study was to compare these procedures in a high-risk cohort.

Methods We retrospectively analyzed all symptomatic (dyspnea or angina) high-risk patients (logistic EuroSCORE ≥ 15%) fulfilling the transcatheter aortic valve implantation (TAVI) indications. Most of the AVR patients (n = 180) were operated on before the implementation of TAVI. All TAVI procedures (n = 127) were performed transapically (TA). After matching for age, logistic EuroSCORE, and left ventricular ejection fraction, 82 pairs of patients were evaluated.

Results When comparing AVR with TA-TAVI, there was no difference between groups in survival after 1 year (Kaplan–Meier analysis, 81.1% [95% CI: 72.5–89.7%] vs. 75.8% [95% CI: 66.2–75.9%], Log tank p = 0.660) and the complication rates (n for AVR vs. TA-TAVI: stroke, 2 vs. 0, p = 0.580; acute renal insufficiency, 8 vs. 12, p = 0.340; atrial fibrillation, 24 vs. 26, p = 0.813; pacemaker implantation, 4 vs. 4, p > 0.999). In addition, quality of life did not differ between groups. Patients in the TA-TAVI group had lower mean valvular gradients postoperatively compared with the AVR group (14.6 ± 6.6 vs. 10.2 ± 4.9 mm Hg, p < 0.001).

Conclusion For high-risk patients, the TAVI procedure is comparable with conventional AVR, but is not advantageous. These results do not support the expansion of TAVI to low- or intermediate-risk patients.