Ramirez-Del Val F, et al. - This study assessed outcomes of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in high-risk patients with porcelain aorta. In findings, an association of TAVI with reduced operative mortality, increased survival, shorter intensive care unit (ICU) and hospital length of stay (LOS) was obvious, compared with SAVR, displaying safety of TAVI in this high-risk population.

Methods

• Between March 2012 and June 2015, a comparison was performed of outcomes of TAVI versus SAVR in high-risk patients with porcelain.

Results

• In TAVI group, there were 54 patients, while 130 SAVR patients with porcelain aorta were identified (operated between 2004 and 2015).
• Both groups were matched 1:1 based on the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score with a 0.5% a priori caliper, resulting in 52 matched pairs.
• Data also showed that for both groups (p=0.98), the mean STS-PROM was 7.3±3.9, while mean age was 77.5 years for TAVI and 78.8 years for SAVR (p=0.46).
• Researchers observed that TAVI vs. SAVR offered lower operative mortality (3.8% vs. 17.3%; p=0.052), significantly shorter median intensive care unit (ICU) (40 vs. 107 hours; p<0.001) and hospital (5 vs. 7 days; p<0.001) length of stay (LOS), but similar postoperative stroke rates (7.7% vs. 11.5%; p=0.74).
• They also noted that 1-year unadjusted survival was 81.7% [95%Confidence Interval (CI): 69.8%–93.5%] in the TAVI group versus 71.2% [95%CI: 61.0%–85.1%] in the SAVR group, p=0.093.
• In addition, it was revealed in Cox proportional hazard modeling that preoperative chronic kidney disease (hazard ratio (HR): 2.63 [95%CI: 1.03–6.70]; p=0.043) and SAVR (HR: 2.641, [95%CI: 1.07–6.51]; p=0.035) were significant predictors for decreased survival.