Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Rheumatic Aortic Stenosis

被引:20
作者
Mentias, Amgad [1 ]
Saad, Marwan [2 ]
Desai, Milind Y. [1 ]
Krishnaswamy, Amar [1 ]
Menon, Venu [1 ]
Horwitz, Phillip A. [3 ]
Kapadia, Samir [1 ]
Sarrazin, Mary Vaughan [3 ,4 ]
机构
[1] Cleveland Clin Fdn, Heart & Vasc Inst, Cleveland, OH USA
[2] Brown Univ, Cardiovasc Inst, Warren Alpert Med Sch, Providence, RI USA
[3] Univ Iowa, Dept Internal Med, Carver Coll Med, Iowa City, IA USA
[4] VA Med Ctr, Comprehens Access & Delivery Res & Evaluat Ctr CA, Iowa City, IA USA
关键词
KEY WORDS rheumatic aortic stenosis; surgical aortic valve replacement; transcatheter aortic valve replacement; POSTOPERATIVE ATRIAL-FIBRILLATION; HEART-DISEASE;
D O I
10.1016/j.jacc.2021.02.032
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
RESULTS The final study cohort included 1,159 patients with rheumatic AS who underwent aortic valve replacement (SAVR, n = 554; TAVR, n = 605), and 88,554 patients with nonrheumatic AS who underwent TAVR. Patients in the SAVR group were younger and with lower prevalence of most comorbidities and frailty scores. After median follow-up of 19 months (interquartile range: 13 to 26 months), there was no difference in all-cause mortality with TAVR versus SAVR (11.2 vs. 7.0 per 100 person-year; adjusted hazard ratio: 1.53; 95% confidence interval: 0.84 to 2.79; p = 0.2). Compared with TAVR in nonrheumatic AS, TAVR for rheumatic AS was associated with similar mortality (15.2 vs. 17.7 deaths per 100 person-years (adjusted hazard ratio: 0.87; 95% confidence interval: 0.68 to 1.09; p = 0.2) after median follow-up of 17 months (interquartile range: 11 to 24 months). None of the rheumatic TAVR patients, <11 SAVR patients, BACKGROUND Patients with rheumatic aortic stenosis (AS) were excluded from transcatheter aortic valve replacement (TAVR) trials. OBJECTIVES The authors sought to examine outcomes with TAVR versus surgical aortic valve replacement (SAVR) in patients with rheumatic AS, and versus TAVR in nonrheumatic AS. METHODS The authors identified Medicare beneficiaries who underwent TAVR or SAVR from October 2015 to December 2017, and then identified patients with rheumatic AS using prior validated International Classification of Diseases, Version 10 codes. Overlap propensity score weighting analysis was used to adjust for measured confounders. The primary study outcome was all-cause mortality. Multiple secondary outcomes were also examined. RESULTS The final study cohort included 1,159 patients with rheumatic AS who underwent aortic valve replacement (SAVR, n = 554; TAVR, n = 605), and 88,554 patients with nonrheumatic AS who underwent TAVR. Patients in the SAVR group were younger and with lower prevalence of most comorbidities and frailty scores. After median follow-up of 19 months (interquartile range: 13 to 26 months), there was no difference in all-cause mortality with TAVR versus SAVR (11.2 vs. 7.0 per 100 person-year; adjusted hazard ratio: 1.53; 95% confidence interval: 0.84 to 2.79; p = 0.2). Compared with TAVR in nonrheumatic AS, TAVR for rheumatic AS was associated with similar mortality (15.2 vs. 17.7 deaths per 100 person-years (adjusted hazard ratio: 0.87; 95% confidence interval: 0.68 to 1.09; p = 0.2) after median follow-up of 17 months (interquartile range: 11 to 24 months). None of the rheumatic TAVR patients, <11 SAVR patients, and 242 nonrheumatic TAVR patients underwent repeat aortic valve replacement (124 redo-TAVR and 118 SAVR) at follow-up. CONCLUSIONS Compared with SAVR, TAVR could represent a viable and possibly durable option for patients with rheumatic AS. (J Am Coll Cardiol 2021;77:1703-13) (c) 2021 by the American College of Cardiology Foundation.
引用
收藏
页码:1703 / 1713
页数:11
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