Isolated surgical vs. transcatheter aortic valve replacement: a propensity score analysis

Background The debate about the optimal approach for aortic valve replacement continues. We compared the hospital and long-term outcomes (survival, aortic valve reintervention, heart failure readmissions, and stroke) between transcatheter vs. surgical (TAVR vs. SAVR) aortic valve replacement. The study included 789 patients; 293 had isolated SAVR, and 496 had isolated TAVR. Patients with concomitant procedures were excluded. Propensity score matching identified 53 matched pairs.Results Patients who had TAVR were significantly older (P (<) 0.001) and had significantly higher EuroSCORE II (P < 0.001), NYHA class (P < 0.001), and more prevalence of diabetes mellitus (P (<) 0.001), hypertension (P < 0.001), chronic lung disease (P = 0.001), recent myocardial infarction (P = 0.002), and heart failure (P < 0.001), stroke (P = 0.02), atrial fibrillation (P = 0.004), and previous percutaneous coronary interventions (P (<) 0.001) than SAVR patients. In the matched cohort, atrial fibrillation occurred more frequently after SAVR (P = 0.01), and hospital stay was significantly longer in SAVR patients (P (< )0.001). There were no differences in hospital mortality between groups (P (>) 0.99). Survival at 1, 3, and 5 years was 97%, 95%, and 94% for SAVR and 91%, 79%, and 58% for TAVR patients. Survival was lower in TAVR patients before matching (P (<) 0.001) and after matching (P = 0.045). Freedom from the composite endpoint of stroke, aortic valve reintervention, and heart failure readmission at 1, 3, and 5 years was 98.9%, 96%, and 94% for SAVR and 94%, 86%, and 75% for TAVR. The composite endpoint was significantly higher in the TAVR group than in SVR before matching (P (<) 0.001), while there was no difference after matching (P = 0.07). There was no significant difference in the change in ejection fraction between groups (beta: -0.88 (95% CI: -2.20-0.43), P = 0.19), and the reduction of the aortic valve peak gradient was significantly higher with TAVR (beta: -7.80 (95% CI: -10.70 to -4.91); P (<) 0.001).Conclusions TAVR could reduce postoperative atrial fibrillation and hospital stay. SAVR could have long-term survival benefits over TAVR with comparable long-term stroke, heart failure readmission, and aortic valve reinterventions between SAVR and TAVR.