Aortic Stenosis Valve Replacement or Valve Implantation? ∗

In this issue of the Journal, Tamburino et al. (1) have published a study that compares the clinical outcomes of aortic valve replacement (AVR) with transcatheter aortic valve replacement (TAVR) at 1 year from the OBSERVANT (Observational Study of Effectiveness of SAVR–TAVR Procedures for Severe Aortic Stenosis Treatment) registry, which investigates the management of aortic stenosis (AS) in 93 institutions in Italy. The registry had 7,618 patients with AS (5,707 treated with AVR and 1,991 with TAVR). The investigators excluded 2,150 patients because of combined procedures, porcelain aortas, “hostile thorax,” nonfemoral TAVR, and protocol violation. A total of 4,077 AVRs and 1,391 transfemoral TAVRs were entered into a propensity score analysis to identify patients with similar pre-operative characteristics. The investigators were able to match 650 patients from each group with very similar clinical profiles. These 2 groups had a mean age of 80 years, 60% were women, and they had a predicted procedure-related mortality risk, which was calculated using the logistic EuroSCORE II, of 5.1% for AVR and 4.9% for TAVR. The primary endpoints were death from any cause and major adverse cardiac and cerebrovascular events (MACCE) at 1 year. MACCE were defined as the composite of death from any cause, stroke, myocardial infarction, percutaneous coronary artery intervention, and coronary artery bypass surgery. Secondary endpoints were cerebrovascular accidents, acute myocardi...
Source: Journal of the American College of Cardiology - Category: Cardiology Source Type: research