Mini-Aortic Valve Replacement versus Transcatheter Aortic Valve Implantation: A Propensity-Matched Study
Corresponding Author
María Monteagudo-Vela
Cardiothoracic Surgery Department, Hospital Universitario de la Princesa, Madrid, Spain madrid.org
Department of Mechanical Circulatory Support and Cardiothoracic Transplantation, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK nhs.uk
Search for more papers by this authorEmilio Monguió-Santín
Cardiothoracic Surgery Department, Hospital Universitario de la Princesa, Madrid, Spain madrid.org
Search for more papers by this authorNieves de Antonio Antón
Cardiothoracic Surgery Department, Hospital Universitario de la Princesa, Madrid, Spain madrid.org
Search for more papers by this authorFernanda Aguirre
Cardiothoracic Surgery Department, Hospital Universitario de la Princesa, Madrid, Spain madrid.org
Search for more papers by this authorBegoña Bernal Gallego
Cardiothoracic Surgery Department, Hospital Universitario de la Princesa, Madrid, Spain madrid.org
Search for more papers by this authorGuillermo Reyes-Copa
Cardiothoracic Surgery Department, Hospital Universitario de la Princesa, Madrid, Spain madrid.org
Search for more papers by this authorVasileios Panoulas
Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK nhs.uk
Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK imperial.ac.uk
Search for more papers by this authorCorresponding Author
María Monteagudo-Vela
Cardiothoracic Surgery Department, Hospital Universitario de la Princesa, Madrid, Spain madrid.org
Department of Mechanical Circulatory Support and Cardiothoracic Transplantation, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK nhs.uk
Search for more papers by this authorEmilio Monguió-Santín
Cardiothoracic Surgery Department, Hospital Universitario de la Princesa, Madrid, Spain madrid.org
Search for more papers by this authorNieves de Antonio Antón
Cardiothoracic Surgery Department, Hospital Universitario de la Princesa, Madrid, Spain madrid.org
Search for more papers by this authorFernanda Aguirre
Cardiothoracic Surgery Department, Hospital Universitario de la Princesa, Madrid, Spain madrid.org
Search for more papers by this authorBegoña Bernal Gallego
Cardiothoracic Surgery Department, Hospital Universitario de la Princesa, Madrid, Spain madrid.org
Search for more papers by this authorGuillermo Reyes-Copa
Cardiothoracic Surgery Department, Hospital Universitario de la Princesa, Madrid, Spain madrid.org
Search for more papers by this authorVasileios Panoulas
Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK nhs.uk
Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK imperial.ac.uk
Search for more papers by this authorAbstract
Background. Total sternotomy for aortic valve replacement has been superseded by less invasive approaches such as mini-sternotomy or transcatheter procedures. There has been an exponential uptake in transcatheter aortic valve implantation (TAVI) in younger and lower risk patients following recent randomized trials. This study aims to compare the outcomes of patients with aortic stenosis treated with minimally invasive approaches: mini-sternotomy for aortic valve replacement (mini-AVR) and TAVI implantation. Methods. Between January 2015 and December 2021, a total of 1437 TAVI and 176 mini-AVR patients from 2 tertiary centers fulfilled the criteria and were included in the propensity matching model. Results. A total of 256 TAVIs and 146 mini-AVR were included in the matched cohort. There was no significant difference in 30-day mortality in the two groups (TAVI vs. mini-AVR 2.7% vs. 2.8%, p = 0.935). TAVI confers slightly lower gradients in the follow-up echo when compared with mini-AVR (peak gradient 20 ± 8.7 mmHg vs. 24.5 ± 10 mmHg, p < 0.001; mean gradient 10.9 ± 5.6 mmHg vs. 13.2 ± 5.7 mmHg, p < 0.001). On the other hand, mini-AVR exhibits remarkably lower rates of paravalvular leak (mild leak 8% vs. 41.5%, p < 0.001; moderate leak 2.8% vs. 0%, p < 0.001) and of need for permanent pacemaker implantation (2% vs. 12.2%, p < 0.001). Unsurprisingly, TAVI has lower in-hospital stay 3 (2 to 6) days vs. 10 (8 to 13) days, p < 0.001). Conclusions. For eligible aortic stenosis patients in the 7th decade of life, mini-AVR remains an excellent therapeutic option.
Conflicts of Interest
Dr. VP has received honoraria from Medtronic.
Open Research
Data Availability
The data underlying this article will be shared upon reasonable request to the corresponding author.
Supporting Information
| Filename | Description |
|---|---|
| jocs9501508-sup-0001-f1.docxWord 2007 document , 48.7 KB | Supplementary Materials Figure 1. Kaplan–Meier curves for primary outcome—all cause mortality up to 30 days. Tables 1 and 2: TAVI (transcatheter aortic valve implantation) and surgical prostheses types and sizes. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1 Kanwar A., Thaden J. J., and Nkomo V. T., Management of patients with aortic valve stenosis, Mayo Clinic Proceedings. (2018) 93, no. 4, 488–508, https://doi.org/10.1016/j.mayocp.2018.01.020, 2-s2.0-85044161687.
- 2 Afshar M., Yazdan-Ashoori S., Engert J. C., and Thanassoulis G., Drugs for prevention and treatment of aortic stenosis: how close are we?, Canadian Journal of Cardiology. (2021) 37, no. 7, 1016–1026, https://doi.org/10.1016/j.cjca.2021.02.017.
- 3 Liakopoulos O. J., Merkle J., Wahlers T., and Choi Y. H., Surgical treatment of aortic valve stenosis, Herz. (2017) 42, no. 6, 542–547, https://doi.org/10.1007/s00059-017-4593-y, 2-s2.0-85021756737.
- 4 Leon M. B., Smith C. R., Mack M., Miller D. C., Moses J. W., Svensson L. G., Tuzcu E. M., Webb J. G., Fontana G. P., Makkar R. R., Brown D. L., Block P. C., Guyton R. A., Pichard A. D., Bavaria J. E., Herrmann H. C., Douglas P. S., Petersen J. L., Akin J. J., Anderson W. N., Wang D., and Pocock S., Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery, New England Journal of Medicine. (2010) 363, no. 17, 1597–1607, https://doi.org/10.1056/nejmoa1008232, 2-s2.0-77958594295.
- 5 Leon M. B., Smith C. R., Mack M. J., Makkar R. R., Svensson L. G., Kodali S. K., Thourani V. H., Tuzcu E. M., Miller D. C., Herrmann H. C., Doshi D., Cohen D. J., Pichard A. D., Kapadia S., Dewey T., Babaliaros V., Szeto W. Y., Williams M. R., Kereiakes D., Zajarias A., Greason K. L., Whisenant B. K., Hodson R. W., Moses J. W., Trento A., Brown D. L., Fearon W. F., Pibarot P., Hahn R. T., Jaber W. A., Anderson W. N., Alu M. C., and Webb J. G., Transcatheter or surgical aortic-valve replacement in intermediate-risk patients, New England Journal of Medicine. (2016) 374, no. 17, 1609–1620, https://doi.org/10.1056/nejmoa1514616, 2-s2.0-84964932839.
- 6 Leon M. B., Mack M. J., Hahn R. T., Thourani V. H., Makkar R., Kodali S. K., Alu M. C., Madhavan M. V., Chau K. H., Russo M., Kapadia S. R., Malaisrie S. C., Cohen D. J., Blanke P., Leipsic J. A., Williams M. R., McCabe J. M., Brown D. L., Babaliaros V., Goldman S., Herrmann H. C., Szeto W. Y., Genereux P., Pershad A., Lu M., Webb J. G., Smith C. R., and Pibarot P., Outcomes 2 Years after transcatheter aortic valve replacement in patients at low surgical risk, Journal of the American College of Cardiology. (2021) 77, no. 9, 1149–1161, https://doi.org/10.1016/j.jacc.2020.12.052.
- 7 Petersen J., Krogmann H., Reichenspurner H., and Girdauskas E., Long-term outcome and quality of life after biological aortic valve replacement in nonelderly adults, The Annals of Thoracic Surgery. (2021) 111, no. 1, 142–149, https://doi.org/10.1016/j.athoracsur.2020.04.097.
- 8 Otto C. M., Nishimura R. A., Bonow R. O., Carabello B. A., Erwin J. P., Gentile F., Jneid H., Krieger E. V., Mack M., McLeod C., O′Gara P. T., Rigolin V. H., Sundt T. M., Thompson A., and Toly C., 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines, Circulation. (2021) 143, no. 5, e72–e227, https://doi.org/10.1161/CIR.0000000000000923.
- 9 Bowdish M. E., Hui D. S., Cleveland J. D., Mack W. J., Sinha R., Ranjan R., Cohen R. G., Baker C. J., Cunningham M. J., Barr M. L., and Starnes V. A., A comparison of aortic valve replacement via an anterior right minithoracotomy with standard sternotomy: a propensity score analysis of 492 patients, European Journal of Cardio-Thoracic Surgery. (2016) 49, no. 2, 456–463, https://doi.org/10.1093/ejcts/ezv038, 2-s2.0-84959905911.
- 10 Chakos A., Wilson-Smith A., Arora S., Nguyen T. C., Dhoble A., Tarantini G., Thielmann M., Vavalle J. P., Wendt D., Yan T., and Tian D. H., Long term outcomes of transcatheter aortic valve implantation (TAVI): a systematic review of 5-year survival and beyond, Annals of Cardiothoracic Surgery. (2017) 6, no. 5, 432–443, https://doi.org/10.21037/acs.2017.09.10, 2-s2.0-85030242415.
- 11 Castrovinci S., Emmanuel S., Moscarelli M., Murana G., Caccamo G., Bertolino E. C., Nasso G., Speziale G., and Fattouch K., Minimally invasive aortic valve surgery, J Geriatr Cardiol. (2016) 13, no. 6, 499–503, https://doi.org/10.11909/j.issn.1671-5411.2016.06.005, 2-s2.0-84982921337.
- 12 Mack M. J., Leon M. B., Thourani V. H., Makkar R., Kodali S. K., Russo M., Kapadia S. R., Malaisrie S. C., Cohen D. J., Pibarot P., Leipsic J., Hahn R. T., Blanke P., Williams M. R., McCabe J. M., Brown D. L., Babaliaros V., Goldman S., Szeto W. Y., Genereux P., Pershad A., Pocock S. J., Alu M. C., Webb J. G., and Smith C. R., Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients, New England Journal of Medicine. (2019) 380, no. 18, 1695–1705, https://doi.org/10.1056/nejmoa1814052, 2-s2.0-85063743385.
- 13 Généreux P., Piazza N., Alu M. C., Nazif T., Hahn R. T., Pibarot P., Bax J. J., Leipsic J. A., Blanke P., Blackstone E. H., Finn M. T., Kapadia S., Linke A., Mack M. J., Makkar R., Mehran R., Popma J. J., Reardon M., Rodes-Cabau J., Van Mieghem N. M., Webb J. G., Cohen D. J., and Leon M. B., Valve academic research consortium 3: updated endpoint definitions for aortic valve clinical research, European Heart Journal. (2021) 42, no. 19, 1825–1857, https://doi.org/10.1093/eurheartj/ehaa799.
- 14 Buist A. S., Similarities and differences between asthma and chronic obstructive pulmonary disease: treatment and early outcomes, European Respiratory Journal. (2003) 21, no. 39, 30–35, https://doi.org/10.1183/09031936.03.00404903.
- 15 Vahanian A., Beyersdorf F., Praz F., Milojevic M., Baldus S., Bauersachs J., Capodanno D., Conradi L., De Bonis M., De Paulis R., Delgado V., Freemantle N., Gilard M., Haugaa K. H., Jeppsson A., Jüni P., Pierard L., Prendergast B. D., Sádaba J. R., Tribouilloy C., Wojakowski W., Neumann F. J., Myers P., Abdelhamid M., Achenbach S., Asteggiano R., Barili F., Borger M. A., Carrel T., Collet J. P., Foldager D., Habib G., Hassager C., Irs A., Iung B., Jahangiri M., Katus H. A., Koskinas K. C., Massberg S., Mueller C. E., Nielsen J. C., Pibarot P., Rakisheva A., Roffi M., Rubboli A., Shlyakhto E., Siepe M., Sitges M., Sondergaard L., Sousa-Uva M., Tarantini G., Zamorano J. L., Praz F., Milojevic M., Baldus S., Bauersachs J., Capodanno D., Conradi L., De Bonis M., De Paulis R., Delgado V., Freemantle N., Gilard M., Haugaa K. H., Jeppsson A., Jüni P., Pierard L., Prendergast B. D., Sádaba J. R., Tribouilloy C., Wojakowski W., Benchabi Y., Chilingaryan A., Metzler B., Rustamova Y., Shumavets V., Lancellotti P., Smajic E., Trendafilova-Lazarova D., Samardzic J., Karakyriou M., Palecek T., Sanchez Dahl J., Meshaal M. S., Palm K., Virtanen M., Bouleti C., Bakhutashvili Z., Achenbach S., Boutsikou M., Kertész A. B., Danielsen R., Topilsky Y., Golino P., Tuleutayev R., Elezi S., Kerimkulov A., Rudzitis A., Glaveckaite S., Sow R., Demarco D. C., Bulatovic N., Aouad A., van den Brink R., Antova E., Beitnes J. O., Ochala A., Ribeiras R., Vinereanu D., Irtyuga O., Ivanovic B., Simkova I., González Gómez A., Sarno G., Pedrazzini G. B., Bsata W., Zakhama L., Korkmaz L., Cherniuk S., Khanji M. Y., and Sharipov I., ESC/EACTS Guidelines for the management of valvular heart disease, European Heart Journal. (2021) 43, no. 7, 561–632, https://doi.org/10.1093/eurheartj/ehab395.
- 16 Pibarot P., Weissman N. J., Stewart W. J., Hahn R. T., Lindman B. R., McAndrew T., Kodali S. K., Mack M. J., Thourani V. H., Miller D. C., Svensson L. G., Herrmann H. C., Smith C. R., Rodés-Cabau J., Webb J., Lim S., Xu K., Hueter I., Douglas P. S., and Leon M. B., Incidence and sequelae of prosthesis-patient mismatch in transcatheter versus surgical valve replacement in high-risk patients with severe aortic stenosis: a PARTNER trial cohort--a analysis, Journal of the American College of Cardiology. (2014) 64, no. 13, 1323–1334, https://doi.org/10.1016/j.jacc.2014.06.1195, 2-s2.0-84908290638.
- 17 Head S. J., Mokhles M. M., Osnabrugge R. L., Pibarot P., Mack M. J., Takkenberg J. J., Bogers A. J., and Kappetein A. P., The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: a systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years, European Heart Journal. (2012) 33, no. 12, 1518–1529, https://doi.org/10.1093/eurheartj/ehs003, 2-s2.0-84863579774.
- 18 Dayan V., Vignolo G., Soca G., Paganini J. J., Brusich D., and Pibarot P., Predictors and outcomes of prosthesis-patient mismatch after aortic valve replacement, Journal of the American College of Cardiology: Cardiovascular Imaging. (2016) 9, no. 8, 924–933, https://doi.org/10.1016/j.jcmg.2015.10.026, 2-s2.0-84969795521.
- 19 Herrmann H. C., Daneshvar S. A., Fonarow G. C., Stebbins A., Vemulapalli S., Desai N. D., Malenka D. J., Thourani V. H., Rymer J., and Kosinski A. S., Prosthesis-patient mismatch in patients undergoing transcatheter aortic valve replacement: from the STS/ACC TVT registry, Journal of the American College of Cardiology. (2018) 72, no. 22, 2701–2711, https://doi.org/10.1016/j.jacc.2018.09.001, 2-s2.0-85056751777.
- 20 Brown M. L., McKellar S. H., Sundt T. M., and Schaff H. V., Ministernotomy versus conventional sternotomy for aortic valve replacement: a systematic review and meta-analysis, The Journal of Thoracic and Cardiovascular Surgery. (2009) 137, no. 3, 670–679.e5, https://doi.org/10.1016/j.jtcvs.2008.08.010, 2-s2.0-60949096825.
- 21 Reardon M. J., Van Mieghem N. M., Popma J. J., Kleiman N. S., Sondergaard L., Mumtaz M., Adams D. H., Deeb G. M., Maini B., Gada H., Chetcuti S., Gleason T., Heiser J., Lange R., Merhi W., Oh J. K., Olsen P. S., Piazza N., Williams M., Windecker S., Yakubov S. J., Grube E., Makkar R., Lee J. S., Conte J., Vang E., Nguyen H., Chang Y., Mugglin A. S., Serruys P. W., and Kappetein A. P., Surgical or transcatheter aortic-valve replacement in intermediate-risk patients, New England Journal of Medicine. (2017) 376, no. 14, 1321–1331, https://doi.org/10.1056/nejmoa1700456, 2-s2.0-85017306295.
- 22 Eggebrecht H., Bestehorn M., Haude M., Schmermund A., Bestehorn K., Voigtlander T., Kuck K. H., and Mehta R. H., Outcomes of transfemoral transcatheter aortic valve implantation at hospitals with and without on-site cardiac surgery department: insights from the prospective German aortic valve replacement quality assurance registry (AQUA) in 17 919 patients, European Heart Journal. (2016) 37, no. 28, 2240–2248, https://doi.org/10.1093/eurheartj/ehw190, 2-s2.0-84978509462.
- 23 Doyle M. P., Woldendorp K., Ng M., Vallely M. P., Wilson M. K., Yan T. D., and Bannon P. G., Minimally-invasive versus transcatheter aortic valve implantation: systematic review with meta-analysis of propensity-matched studies, Journal of Thoracic Disease. (2021) 13, no. 3, 1671–1683, https://doi.org/10.21037/jtd-20-2233.
- 24 Miceli A., Gilmanov D., Murzi M., Marchi F., Ferrarini M., Cerillo A. G., Quaini E., Solinas M., Berti S., and Glauber M., Minimally invasive aortic valve replacement with a sutureless valve through a right anterior mini-thoracotomy versus transcatheter aortic valve implantation in high-risk patients, European Journal of Cardio-Thoracic Surgery. (2016) 49, no. 3, 960–965, https://doi.org/10.1093/ejcts/ezv210, 2-s2.0-84962914873.
