Several studies have compared transcatheter versus surgical aortic valve replacement. In the surgical arm the operations were predominantly performed with full sternotomy access. There is increasing evidence that a minimally invasive approach (mini-AVR) is a safe alternative to sternotomy and has demonstrated to reduce postoperative morbidity and inflammatory reaction. The aim of this study is to compare early outcome of patients undergone transcatheter aortic valve replacement (TAVR) or mini-AVR.
Prospectively collected clinical and administrative data of 9 cardiac centers were reviewed. Between January 2011 and December 2016, 2407 patients underwent mini-AVR and 497 received TAVR. Additive EuroSCORE, age, gender and ejection fraction were utilized to account for disparities creating two matched groups for comparisons.
In the mini-AVR group 35.3% of the operations were performed through a right anterior mini-thoracotomy and 64.7% through a partial J sternotomy. In the TAVR group, procedures were predominantly performed through transfemoral access.
After matching, two groups of 325 patients each were analyzed with mean age of 80 ± 6 years and additive EuroSCORE of 8.6. No significant difference in mortality and stroke occurrence was observed. Patients in the mini-AVR group experienced more frequently blood transfusion, acute kideny injury and had longer hospital stay. Patients in TAVR group required more frequently permanent pace maker insertion.
Our matched analysis identified patients with aortic valve pathology at intermediate/high risk. Mini-AVR and TAVR produced similar and satisfactory results. Minimally invasive aortic valve replacement should be utilized for future prospective comparisons between surgical and transcatheter aortic valve therapy.
1Ospedale Santa Maria, GVM Care & Research, Università di Bari Bari
2Ospedale Città di Lecce, GVM Care & Research Lecce
3Ospedale Santa Maria, GVM Care & Research Bari
4Anthea Hospital, GVM Care & Research Bari
5ICLAS - ISTITUTO CLINICO LIGURE DI ALTA SPECIALITÀ Rapallo
6Maria Pia Hospital, GVM Care & Research Torino
7Maria Cecilia Hospital, GVM Care & Research Cotignola