Cardiovascular diagnosis and therapy · 2025
Comparison of TAVR and SAVR in elderly patients with pure native aortic regurgitation: outcomes and midterm results.
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Zhao Cheng, Xue Chao, Fu Jintao, Li Fei, Li Yuehuan, Zhao Yichen, Bartus Krzysztof, Zhang Haibo, Wang Jiangang
Аннотация
BACKGROUND: Aortic regurgitation (AR) is a common valvular disease, but data comparing surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) for pure native AR are limited. The aim of this study is to provide more robust evidence for employing TAVR in patients with pure native AR.
METHODS: This retrospective cohort study included 208 elderly patients (≥65 years) with pure native AR who underwent elective aortic valve replacement (SAVR or TAVR, all patients underwent TAVR procedure using the J-Valve™ system) between January 2018 and June 2023 at Beijing Anzhen Hospital, China. Safety and hemodynamic outcomes were assessed up to 3.1 years [interquartile range (IQR), 1.9-4.8 years], with propensity score weighting used to adjust for confounders.
RESULTS: The median ages were 74.0 in the TAVR group and 68.0 in the SAVR group. SAVR patients were younger and had fewer comorbidities. The all-cause mortality in the TAVR group during the in-hospital period was significantly higher than the SAVR group after adjustment (15.8% vs. 6.6%; P=0.003), while there was no statistical difference in cardiac mortality between the two groups (4.3% vs. 3.3%; P=0.58). The TAVR group saw more adverse results in terms of the requirement for a permanent pacemaker (11.5% vs. 0.0%; P<0.001) and vascular complications (8.7% vs. 0.0%; P<0.001) during the in-hospital period after adjustment. No significant statistical difference all-cause stroke, acute myocardial infarction, and aortic valve redo both during the in-hospital period and follow-up. Before discharge, TAVR patients had significantly larger effective orifice area (EOA) [median 2.1 (IQR, 2.0-2.2) vs. 1.6 (IQR, 1.5-1.8) cm2; P<0.001] and EOA index [median 1.2 (IQR, 1.1-1.3) vs. 0.9 (IQR, 0.8-1.0) cm2/m2; P<0.001] compared to SAVR patients. The maximum aortic valve velocity [median 180.6 (IQR, 151.0-208.0) vs. 236.1 (IQR, 212.0-253.0) cm/s; P<0.001] and pressure gradient [median 13.9 (IQR, 9.0-17.0) vs. 23.2 (IQR, 19.0-27.0) mmHg; P<0.001] were also lower in the TAVR group before discharge. These hemodynamic advantages persisted during follow-up.
CONCLUSIONS: TAVR patients with pure native AR were older, had more comorbidities, and had higher Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) scores than SAVR patients. Cardiac mortality was similar between groups during hospitalization and follow-up. TAVR is a safe and effective treatment for elderly patients with pure native AR, providing superior hemodynamic performance and the potential for improved long-term outcomes.
METHODS: This retrospective cohort study included 208 elderly patients (≥65 years) with pure native AR who underwent elective aortic valve replacement (SAVR or TAVR, all patients underwent TAVR procedure using the J-Valve™ system) between January 2018 and June 2023 at Beijing Anzhen Hospital, China. Safety and hemodynamic outcomes were assessed up to 3.1 years [interquartile range (IQR), 1.9-4.8 years], with propensity score weighting used to adjust for confounders.
RESULTS: The median ages were 74.0 in the TAVR group and 68.0 in the SAVR group. SAVR patients were younger and had fewer comorbidities. The all-cause mortality in the TAVR group during the in-hospital period was significantly higher than the SAVR group after adjustment (15.8% vs. 6.6%; P=0.003), while there was no statistical difference in cardiac mortality between the two groups (4.3% vs. 3.3%; P=0.58). The TAVR group saw more adverse results in terms of the requirement for a permanent pacemaker (11.5% vs. 0.0%; P<0.001) and vascular complications (8.7% vs. 0.0%; P<0.001) during the in-hospital period after adjustment. No significant statistical difference all-cause stroke, acute myocardial infarction, and aortic valve redo both during the in-hospital period and follow-up. Before discharge, TAVR patients had significantly larger effective orifice area (EOA) [median 2.1 (IQR, 2.0-2.2) vs. 1.6 (IQR, 1.5-1.8) cm2; P<0.001] and EOA index [median 1.2 (IQR, 1.1-1.3) vs. 0.9 (IQR, 0.8-1.0) cm2/m2; P<0.001] compared to SAVR patients. The maximum aortic valve velocity [median 180.6 (IQR, 151.0-208.0) vs. 236.1 (IQR, 212.0-253.0) cm/s; P<0.001] and pressure gradient [median 13.9 (IQR, 9.0-17.0) vs. 23.2 (IQR, 19.0-27.0) mmHg; P<0.001] were also lower in the TAVR group before discharge. These hemodynamic advantages persisted during follow-up.
CONCLUSIONS: TAVR patients with pure native AR were older, had more comorbidities, and had higher Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) scores than SAVR patients. Cardiac mortality was similar between groups during hospitalization and follow-up. TAVR is a safe and effective treatment for elderly patients with pure native AR, providing superior hemodynamic performance and the potential for improved long-term outcomes.