Surgical and transcatheter aortic valve replacement for severe aortic stenosis in low-risk elective patients: Analysis of the Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry

Adam R Kowalówka; Mariusz Kowalewski; Wojciech Wańha; Michalina Kołodziejczak; Silvia Mariani; Tong Li; Michał Pasierski; Andrzej Łoś; Sebastian Stefaniak; Marcin Malinowski; Radoslaw Gocoł; Damian Hudziak; Ryszard Bachowski; Wojciech Wojakowski; Marek Jemielity; Jan Rogowski; Roberto Lorusso; Piotr Suwalski; Marek Deja

doi:10.1016/j.jtcvs.2022.10.026

Surgical and transcatheter aortic valve replacement for severe aortic stenosis in low-risk elective patients: Analysis of the Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry

Adam R Kowalówka, Mariusz Kowalewski^*, Wojciech Wańha, Michalina Kołodziejczak, Silvia Mariani, Tong Li, Michał Pasierski, Andrzej Łoś, Sebastian Stefaniak, Marcin Malinowski, Radoslaw Gocoł, Damian Hudziak, Ryszard Bachowski, Wojciech Wojakowski, Marek Jemielity, Jan Rogowski, Roberto Lorusso, Piotr Suwalski, Marek Deja

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: Transcatheter aortic valve implantation (TAVI) remains the preferred strategy for high-risk or elderly individuals with aortic valve (AV) stenosis who are not considered to be optimal surgical candidates. Recent evidence suggests that low-risk patients may benefit from TAVI as well. The current study evaluates midterm survival in low-risk patients undergoing elective surgical AV replacement (SAVR) versus TAVI.

METHODS: The Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry (AVALON) compared isolated elective transfemoral TAVI or SAVR with sternotomy or minimally invasive approach in low-risk individuals performed between 2015 and 2019. Propensity score matching was conducted to determine SAVR controls for TAVI group in a 1-to-3 ratio with 0.2 caliper.

RESULTS: A total of 2393 patients undergoing elective surgery (1765 SAVR and 629 TAVI) with median European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) score 1.81 (interquartile range [IQR], 1.36 to 2.53]) were initially included. Median follow-up was 2.72 years (IQR, 1.32-4.08; max 6.0). Propensity score matching returned 329 TAVI cases and 593 SAVR controls. Thirty-day mortality was 11 out of 329 (3.32%) in TAVI and 18 out of 593 (3.03%) in SAVR (risk ratio, 1.10; 95% CI, 0.52-2.37; P = .801) groups, respectively. At 2 years, survival curves began to diverge in favor of SAVR, which was associated with 30% lower mortality (hazard ratio, 0.70; 95% CI, 0.496-0.997; P = .048).

CONCLUSIONS: Our data did not demonstrate a survival difference between TAVI and SAVR during the first 2 postprocedure years. After that time, SAVR is associated with improved survival. Extended observations from randomized trials in low-risk patients undergoing elective surgery are warranted to confirm these findings and draw definitive conclusions.

Original language	English
Journal	Journal of Thoracic and Cardiovascular Surgery
DOIs	https://doi.org/10.1016/j.jtcvs.2022.10.026
Publication status	E-pub ahead of print - 28 Oct 2022

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10.1016/j.jtcvs.2022.10.026

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Kowalówka, A. R., Kowalewski, M., Wańha, W., Kołodziejczak, M., Mariani, S., Li, T., Pasierski, M., Łoś, A., Stefaniak, S., Malinowski, M., Gocoł, R., Hudziak, D., Bachowski, R., Wojakowski, W., Jemielity, M., Rogowski, J., Lorusso, R., Suwalski, P., & Deja, M. (2022). Surgical and transcatheter aortic valve replacement for severe aortic stenosis in low-risk elective patients: Analysis of the Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry. Journal of Thoracic and Cardiovascular Surgery. Advance online publication. https://doi.org/10.1016/j.jtcvs.2022.10.026

@article{07f45c9f00454531a2f54c2619ea1da4,

title = "Surgical and transcatheter aortic valve replacement for severe aortic stenosis in low-risk elective patients: Analysis of the Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry",

abstract = "OBJECTIVES: Transcatheter aortic valve implantation (TAVI) remains the preferred strategy for high-risk or elderly individuals with aortic valve (AV) stenosis who are not considered to be optimal surgical candidates. Recent evidence suggests that low-risk patients may benefit from TAVI as well. The current study evaluates midterm survival in low-risk patients undergoing elective surgical AV replacement (SAVR) versus TAVI.METHODS: The Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry (AVALON) compared isolated elective transfemoral TAVI or SAVR with sternotomy or minimally invasive approach in low-risk individuals performed between 2015 and 2019. Propensity score matching was conducted to determine SAVR controls for TAVI group in a 1-to-3 ratio with 0.2 caliper.RESULTS: A total of 2393 patients undergoing elective surgery (1765 SAVR and 629 TAVI) with median European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) score 1.81 (interquartile range [IQR], 1.36 to 2.53]) were initially included. Median follow-up was 2.72 years (IQR, 1.32-4.08; max 6.0). Propensity score matching returned 329 TAVI cases and 593 SAVR controls. Thirty-day mortality was 11 out of 329 (3.32%) in TAVI and 18 out of 593 (3.03%) in SAVR (risk ratio, 1.10; 95% CI, 0.52-2.37; P = .801) groups, respectively. At 2 years, survival curves began to diverge in favor of SAVR, which was associated with 30% lower mortality (hazard ratio, 0.70; 95% CI, 0.496-0.997; P = .048).CONCLUSIONS: Our data did not demonstrate a survival difference between TAVI and SAVR during the first 2 postprocedure years. After that time, SAVR is associated with improved survival. Extended observations from randomized trials in low-risk patients undergoing elective surgery are warranted to confirm these findings and draw definitive conclusions.",

author = "Kowal{\'o}wka, {Adam R} and Mariusz Kowalewski and Wojciech Wa{\'n}ha and Michalina Ko{\l}odziejczak and Silvia Mariani and Tong Li and Micha{\l} Pasierski and Andrzej {\L}o{\'s} and Sebastian Stefaniak and Marcin Malinowski and Radoslaw Goco{\l} and Damian Hudziak and Ryszard Bachowski and Wojciech Wojakowski and Marek Jemielity and Jan Rogowski and Roberto Lorusso and Piotr Suwalski and Marek Deja",

year = "2022",

month = oct,

day = "28",

doi = "10.1016/j.jtcvs.2022.10.026",

language = "English",

journal = "Journal of Thoracic and Cardiovascular Surgery",

issn = "0022-5223",

publisher = "MOSBY-ELSEVIER",

}

Kowalówka, AR, Kowalewski, M, Wańha, W, Kołodziejczak, M, Mariani, S, Li, T, Pasierski, M, Łoś, A, Stefaniak, S, Malinowski, M, Gocoł, R, Hudziak, D, Bachowski, R, Wojakowski, W, Jemielity, M, Rogowski, J, Lorusso, R, Suwalski, P & Deja, M 2022, 'Surgical and transcatheter aortic valve replacement for severe aortic stenosis in low-risk elective patients: Analysis of the Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry', Journal of Thoracic and Cardiovascular Surgery. https://doi.org/10.1016/j.jtcvs.2022.10.026

Surgical and transcatheter aortic valve replacement for severe aortic stenosis in low-risk elective patients: Analysis of the Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry. / Kowalówka, Adam R; Kowalewski, Mariusz; Wańha, Wojciech et al.
In: Journal of Thoracic and Cardiovascular Surgery, 28.10.2022.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Surgical and transcatheter aortic valve replacement for severe aortic stenosis in low-risk elective patients

T2 - Analysis of the Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry

AU - Kowalówka, Adam R

AU - Kowalewski, Mariusz

AU - Wańha, Wojciech

AU - Kołodziejczak, Michalina

AU - Mariani, Silvia

AU - Li, Tong

AU - Pasierski, Michał

AU - Łoś, Andrzej

AU - Stefaniak, Sebastian

AU - Malinowski, Marcin

AU - Gocoł, Radoslaw

AU - Hudziak, Damian

AU - Bachowski, Ryszard

AU - Wojakowski, Wojciech

AU - Jemielity, Marek

AU - Rogowski, Jan

AU - Lorusso, Roberto

AU - Suwalski, Piotr

AU - Deja, Marek

PY - 2022/10/28

Y1 - 2022/10/28

N2 - OBJECTIVES: Transcatheter aortic valve implantation (TAVI) remains the preferred strategy for high-risk or elderly individuals with aortic valve (AV) stenosis who are not considered to be optimal surgical candidates. Recent evidence suggests that low-risk patients may benefit from TAVI as well. The current study evaluates midterm survival in low-risk patients undergoing elective surgical AV replacement (SAVR) versus TAVI.METHODS: The Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry (AVALON) compared isolated elective transfemoral TAVI or SAVR with sternotomy or minimally invasive approach in low-risk individuals performed between 2015 and 2019. Propensity score matching was conducted to determine SAVR controls for TAVI group in a 1-to-3 ratio with 0.2 caliper.RESULTS: A total of 2393 patients undergoing elective surgery (1765 SAVR and 629 TAVI) with median European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) score 1.81 (interquartile range [IQR], 1.36 to 2.53]) were initially included. Median follow-up was 2.72 years (IQR, 1.32-4.08; max 6.0). Propensity score matching returned 329 TAVI cases and 593 SAVR controls. Thirty-day mortality was 11 out of 329 (3.32%) in TAVI and 18 out of 593 (3.03%) in SAVR (risk ratio, 1.10; 95% CI, 0.52-2.37; P = .801) groups, respectively. At 2 years, survival curves began to diverge in favor of SAVR, which was associated with 30% lower mortality (hazard ratio, 0.70; 95% CI, 0.496-0.997; P = .048).CONCLUSIONS: Our data did not demonstrate a survival difference between TAVI and SAVR during the first 2 postprocedure years. After that time, SAVR is associated with improved survival. Extended observations from randomized trials in low-risk patients undergoing elective surgery are warranted to confirm these findings and draw definitive conclusions.

AB - OBJECTIVES: Transcatheter aortic valve implantation (TAVI) remains the preferred strategy for high-risk or elderly individuals with aortic valve (AV) stenosis who are not considered to be optimal surgical candidates. Recent evidence suggests that low-risk patients may benefit from TAVI as well. The current study evaluates midterm survival in low-risk patients undergoing elective surgical AV replacement (SAVR) versus TAVI.METHODS: The Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry (AVALON) compared isolated elective transfemoral TAVI or SAVR with sternotomy or minimally invasive approach in low-risk individuals performed between 2015 and 2019. Propensity score matching was conducted to determine SAVR controls for TAVI group in a 1-to-3 ratio with 0.2 caliper.RESULTS: A total of 2393 patients undergoing elective surgery (1765 SAVR and 629 TAVI) with median European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) score 1.81 (interquartile range [IQR], 1.36 to 2.53]) were initially included. Median follow-up was 2.72 years (IQR, 1.32-4.08; max 6.0). Propensity score matching returned 329 TAVI cases and 593 SAVR controls. Thirty-day mortality was 11 out of 329 (3.32%) in TAVI and 18 out of 593 (3.03%) in SAVR (risk ratio, 1.10; 95% CI, 0.52-2.37; P = .801) groups, respectively. At 2 years, survival curves began to diverge in favor of SAVR, which was associated with 30% lower mortality (hazard ratio, 0.70; 95% CI, 0.496-0.997; P = .048).CONCLUSIONS: Our data did not demonstrate a survival difference between TAVI and SAVR during the first 2 postprocedure years. After that time, SAVR is associated with improved survival. Extended observations from randomized trials in low-risk patients undergoing elective surgery are warranted to confirm these findings and draw definitive conclusions.

U2 - 10.1016/j.jtcvs.2022.10.026

DO - 10.1016/j.jtcvs.2022.10.026

M3 - Article

C2 - 36424214

SN - 0022-5223

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

ER -

Kowalówka AR, Kowalewski M, Wańha W, Kołodziejczak M, Mariani S, Li T et al. Surgical and transcatheter aortic valve replacement for severe aortic stenosis in low-risk elective patients: Analysis of the Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry. Journal of Thoracic and Cardiovascular Surgery. 2022 Oct 28. Epub 2022 Oct 28. doi: 10.1016/j.jtcvs.2022.10.026