Reconsidered surgical aortic valve replacement after declined transcatheter valve implantation
Reconsidered surgical aortic valve replacement after declined transcatheter valve implantation
Background: outcomes for high surgical risk patients who declined transcatheter aortic valve implantation (TAVI) and then reconsidered for conventional aortic valve replacement (rSAVR) for severe calcific aortic stenosis are not well known.
Methods: this single-centre, case–control study (rSAVR vs Conservative group) retrospectively analysed patients for rSAVR (2009–2019). Multivariable logistic regression was used to identify independent predictors of composite of neurological sequelae/renal failure/deep sternal wound infection/re-exploration and death. Survival was compared using Kaplan–Meier curves and log-rank test. A Cox proportional hazards model was used to determine predictors of survival.
Results: TAVI was denied in 519/1095 patients, 114(10.4%) had rSAVR (cases) and 405 (37%) were managed conservatively (controls). Mean age for rSAVR was 80 years (IQR: 73.5–85 years). The commonest reason for declining TAVI was prohibitive high risk due to multiple comorbidities. Among rSAVR, hospital mortality was 2.2% and stroke was 4.4%. Median follow-up was conservative; 14.4 months versus rSAVR; 34.8 months. Five-year survival was conservative; 12.6% versus rSAVR; and 59.5% (overall conservative; 38.0% vs. rSAVR; 60.5%, p < 0.001). rSAVR was protective (hazard ratio [HR]: 0.37, 95% confidence interval [CI]: 0.26, 0.51, p < 0.001) and high comorbidities had high hazard (HR: 1.57, 95% CI: 1.19, 2.07, p = 0.001). rSAVR had fewer hospital readmission episodes (Conservative; 13.6/patient-year vs. rSAVR; 6.9/patient-year, p = 0.002).
Conclusions: rSAVR may be considered in high surgical risk elderly patients who have been declined TAVI in centres with low operative mortality. rSAVR may be superior to conservative management in carefully selected patients.
Aortic valve replacement, transcatheter valve implantation
1001-1009
Luthra, Suvitesh
2571de06-62b5-4b54-9858-6c065136e8f2
Leiva-juarez, Miguel M.
486c3e3c-83f4-46bd-9479-8ebf05942c88
Malvindi, Pietro G.
0b93e241-b408-44cc-a33c-8cbe63eb3475
Navaratanaraja, Manoraj
1432ef07-d20e-484b-a19c-08a1e4454322
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Ohri, Sunil K.
8aa5698c-78cf-4f59-a5af-5afa46f0348c
1 November 2022
Luthra, Suvitesh
2571de06-62b5-4b54-9858-6c065136e8f2
Leiva-juarez, Miguel M.
486c3e3c-83f4-46bd-9479-8ebf05942c88
Malvindi, Pietro G.
0b93e241-b408-44cc-a33c-8cbe63eb3475
Navaratanaraja, Manoraj
1432ef07-d20e-484b-a19c-08a1e4454322
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Ohri, Sunil K.
8aa5698c-78cf-4f59-a5af-5afa46f0348c
Luthra, Suvitesh, Leiva-juarez, Miguel M., Malvindi, Pietro G., Navaratanaraja, Manoraj, Curzen, Nick and Ohri, Sunil K.
(2022)
Reconsidered surgical aortic valve replacement after declined transcatheter valve implantation.
Asian Cardiovascular and Thoracic Annals, 30 (9), .
(doi:10.1177/02184923221132202).
Abstract
Background: outcomes for high surgical risk patients who declined transcatheter aortic valve implantation (TAVI) and then reconsidered for conventional aortic valve replacement (rSAVR) for severe calcific aortic stenosis are not well known.
Methods: this single-centre, case–control study (rSAVR vs Conservative group) retrospectively analysed patients for rSAVR (2009–2019). Multivariable logistic regression was used to identify independent predictors of composite of neurological sequelae/renal failure/deep sternal wound infection/re-exploration and death. Survival was compared using Kaplan–Meier curves and log-rank test. A Cox proportional hazards model was used to determine predictors of survival.
Results: TAVI was denied in 519/1095 patients, 114(10.4%) had rSAVR (cases) and 405 (37%) were managed conservatively (controls). Mean age for rSAVR was 80 years (IQR: 73.5–85 years). The commonest reason for declining TAVI was prohibitive high risk due to multiple comorbidities. Among rSAVR, hospital mortality was 2.2% and stroke was 4.4%. Median follow-up was conservative; 14.4 months versus rSAVR; 34.8 months. Five-year survival was conservative; 12.6% versus rSAVR; and 59.5% (overall conservative; 38.0% vs. rSAVR; 60.5%, p < 0.001). rSAVR was protective (hazard ratio [HR]: 0.37, 95% confidence interval [CI]: 0.26, 0.51, p < 0.001) and high comorbidities had high hazard (HR: 1.57, 95% CI: 1.19, 2.07, p = 0.001). rSAVR had fewer hospital readmission episodes (Conservative; 13.6/patient-year vs. rSAVR; 6.9/patient-year, p = 0.002).
Conclusions: rSAVR may be considered in high surgical risk elderly patients who have been declined TAVI in centres with low operative mortality. rSAVR may be superior to conservative management in carefully selected patients.
Text
Reconsidered TAVI manuscript manuscript v3
- Accepted Manuscript
Text
Reconsidered TAVI tables v2
- Accepted Manuscript
More information
e-pub ahead of print date: 10 October 2022
Published date: 1 November 2022
Keywords:
Aortic valve replacement, transcatheter valve implantation
Identifiers
Local EPrints ID: 474131
URI: http://eprints.soton.ac.uk/id/eprint/474131
ISSN: 0218-4923
PURE UUID: f3160ed7-eff5-4261-ada1-8342f62ccb4f
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Date deposited: 14 Feb 2023 17:35
Last modified: 17 Mar 2024 03:02
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Contributors
Author:
Suvitesh Luthra
Author:
Miguel M. Leiva-juarez
Author:
Pietro G. Malvindi
Author:
Manoraj Navaratanaraja
Author:
Sunil K. Ohri
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