Selection for transcatheter versus surgical aortic valve replacement and mid-term survival: results of the AUTHEARTVISIT study

被引:6
作者
Auer, Johann [1 ]
Krotka, Pavla [2 ]
Reichardt, Berthold [3 ]
Traxler, Denise [4 ,5 ,6 ]
Wendt, Ralph [7 ]
Mildner, Michael [8 ]
Ankersmit, Hendrik Jan [4 ,5 ]
Graf, Alexandra [2 ]
机构
[1] St Josef Hosp Braunau, Dept Internal Med Cardiol & Intens Care 1, Braunau, Austria
[2] Med Univ Vienna, Ctr Med Data Sci, Vienna, Austria
[3] Austrian Social Hlth Insurance Fund, Eisenstadt, Austria
[4] Med Univ Vienna, Clin Thorac Surg, Vienna, Austria
[5] Lab Cardiac & Thorac Diag Regenerat & Appl Immunol, Vienna, Austria
[6] Med Univ Vienna, Dept Oral & Maxillofacial Surg, Vienna, Austria
[7] Hosp St Georg, Dept Nephrol, Leipzig, Germany
[8] Med Univ Vienna, Dept Dermatol, Vienna, Austria
关键词
Transcatheter aortic valve replacement; Bioprosthesis; AUTHEARTVISIT; RANDOMIZED-TRIALS; HEALTH-CARE; OUTCOMES; STENOSIS;
D O I
10.1093/ejcts/ezae214
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES: Limited data are available from randomized trials comparing outcomes between transcatheter aortic valve replacement (TAVR) and surgery in patients with different risks and with follow-up of at least 4 years or longer. In this large, population-based cohort study, long-term mortality and morbidity were investigated in patients undergoing aortic valve replacement (AVR) for severe aortic stenosis using a surgically implanted bioprosthesis (surgical/biological aortic valve replacement; sB-AVR) or TAVR. METHODS: Individual data from the Austrian Insurance Funds from 2010 through 2020 were analysed. The primary outcome was all-cause mortality, assessed in the overall and propensity score-matched populations. Secondary outcomes included reoperation and cardiovascular events. RESULTS: From January 2010 through December 2020, a total of 18 882 patients underwent sB-AVR (n = 11 749; 62.2%) or TAVR (n = 7133; 37.8%); median follow-up was 5.8 (95% CI 5.7-5.9) years (maximum 12.3 years). The risk of all-cause mortality was higher with TAVR compared with sB-AVR: hazard ratio 1.552, 95% confidence interval (CI) 1.469-1.640, P < 0.001; propensity score-matched hazard ratio 1.510, 1.403-1.625, P < 0.001. Estimated median survival was 8.8 years (95% CI 8.6-9.1) with sB-AVR versus 5 years (4.9-5.2) with TAVR. Estimated 5-year survival probability was 0.664 (0.664-0.686) with sB-AVR versus 0.409 (0.378-0.444) with TAVR overall, and 0.690 (0.674-0.707) and 0.560 (0.540-0.582), respectively, with propensity score matching. Separate subgroup analyses for patients aged 65-75 years and >75 years indicated a significant survival benefit in patients selected for sB-AVR in both groups. Other predictors of mortality were age, sex, previous heart failure, diabetes and chronic kidney disease. CONCLUSIONS: In this retrospective national population-based study, selection for TAVR was significantly associated with higher all-cause mortality compared with sB-AVR in patients >= 65 years with severe, symptomatic aortic stenosis in the >2-year follow-up.
引用
收藏
页数:10
相关论文
共 32 条
  • [31] Emulation of Randomized Clinical Trials With Nonrandomized Database Analyses Results of 32 Clinical Trials
    Wang, Shirley V.
    Schneeweiss, Sebastian
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2023, 329 (16): : 1376 - 1385
  • [32] The Learning Curve and Annual Procedure Volume Standards for Optimum Outcomes of Transcatheter Aortic Valve Replacement Findings From an International Registry
    Wassef, Anthony W. A.
    Rodes-Cabau, Josep
    Liu, Yaqing
    Webb, John G.
    Barbanti, Marco
    Munoz-Garcia, Antonio J.
    Tamburino, Corrado
    Dager, Antonio E.
    Serra, Vicenc
    Amat-Santos, Ignacio J.
    Alonso Briales, Juan H.
    San Roman, Alberto
    Urena, Marina
    Himbert, Dominique
    Nombela-Franco, Lius
    Abizaid, Alexandre
    de Brito, Fabio S., Jr.
    Ribeiro, Henrique B.
    Ruel, Marc
    Lima, Valter C.
    Nietlispach, Fabian
    Cheema, Asim N.
    [J]. JACC-CARDIOVASCULAR INTERVENTIONS, 2018, 11 (17) : 1669 - 1679