Comparison of the Outcomes between Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Replacement in Patients Aged above 80.
10.5090/kjtcs.2017.50.4.255
- Author:
Jeong Woo LEE
1
;
Jihoon KIM
;
Sung Ho JUNG
;
Cheol Hyun CHUNG
;
Jae Won LEE
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea. csjung@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Aortic valve, surgery;
Heart valve disease;
Outcomes;
Transcatheter aortic valve replacement
- MeSH:
Aged;
Aortic Valve*;
Atrial Fibrillation;
Chungcheongnam-do;
Dialysis;
Echocardiography;
Follow-Up Studies;
Heart Valve Diseases;
Humans;
Length of Stay;
Mortality;
Renal Insufficiency;
Transcatheter Aortic Valve Replacement*
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2017;50(4):255-262
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has been suggested as a less invasive treatment for high-risk patients with aortic valve disease. In this study, we compared the outcomes of conventional surgical aortic valve replacement (AVR) and TAVR in elderly patients aged over 80. METHODS: A total of 108 patients aged 80 years or older who underwent isolated AVR (n=35) or TAVR (n=73) from 2010 through 2015 at Asan Medical Center were identified. Early and late clinical outcomes, including echocardiographic findings, were evaluated in both groups. The mean follow-up duration was 766.4±528.7 days in the AVR group and 755.2±546.6 days in the TAVR group, and the average timing of the last follow-up echocardiography was at 492.6±512.5 days in the AVR group and 515.7±526.8 days in the TAVR group. RESULTS: The overall early mortality was 2.8% (0 of 35, 0% in the AVR group vs. 3 of 73, 4.1% in the TAVR group). Permanent pacemaker insertion was significantly more common in the TAVR group (p=0.010). Renal failure requiring dialysis and new-onset atrial fibrillation was more frequent and the length of hospital stay was longer in the AVR group; however, this difference did not reach statistical significance. In the TAVR group, 14 patients (19.2%) were rehospitalized due to cardiac problems, and 13 patients (17.8%) had developed significant paravalvular leakage by the time of the last follow-up echocardiography. CONCLUSION: TAVR could be a good alternative to conventional surgical AVR in elderly patients. However, TAVR has several shortcomings, such as frequent significant paravalvular leakage or readmission, which should be considered in decision-making.
