Boute Marin, De Azevedo David, de Terwangne Christophe, Pouleur Anne-Catherine, Pasquet Agnès, Gerber Bernhard L, de Kerchove Laurent, Beauloye Christophe, Kefer Joëlle, Maes Frédéric, Pierard Sophie, Vancraeynest David
Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium.
Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Front Cardiovasc Med. 2025 Apr 11;12:1547456. doi: 10.3389/fcvm.2025.1547456. eCollection 2025.
Comparative long-term survival outcomes between transcatheter (TAVR) and surgical (SAVR) aortic valve replacement remain debated. While randomized controlled trials support TAVR's non-inferiority, real-world data indicate the opposite. Comparing SAVR and TAVR patients with matched reference populations may reduce bias from direct comparisons. We compared the 5-year overall survival rates of SAVR, non-frail TAVR, and frail TAVR patients with those of matched general population standards.
All patients who underwent bioprosthetic SAVR or TAVR at a tertiary hospital from 2012 to 2021 were included. Based on intervention type and Clinical Frailty Scale, patients were divided into three groups: SAVR, non-frail TAVR, and frail TAVR. Survival was compared to individual-level age- and sex-matched general population data using standardized mortality ratios (SMRs).
The cohort included 939 SAVR, 328 non-frail TAVR, and 121 frail TAVR patients, with mean ages of 73.6, 85.3, and 85.6 years, and median EuroSCORE II values of 1.9%, 4.0%, and 5.2%, respectively. SAVR and non-frail TAVR patients had survival rates comparable to those of the reference population [SMR = 0.93 [0.76-1.14]; = 0.437 and SMR = 0.94 [0.76-1.15]; = 0.468]. Conversely, frail TAVR patients faced a 40% increased mortality risk compared with their reference population [SMR = 1.40 (1.04-1.88); = 0.012].
In non-frail patients, TAVR and SAVR both restore life expectancy to general population standards. For frail TAVR patients, the lower survival rate highlights frailty's important prognostic impact and underlines the ongoing challenge of refining patient selection to avoid futility.
经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（SAVR）之间的长期生存结果比较仍存在争议。虽然随机对照试验支持TAVR的非劣效性，但真实世界的数据却显示相反的结果。将SAVR和TAVR患者与匹配的参考人群进行比较可能会减少直接比较带来的偏差。我们比较了SAVR、非虚弱型TAVR和虚弱型TAVR患者与匹配的一般人群标准的5年总生存率。
纳入2012年至2021年在一家三级医院接受生物人工心脏瓣膜SAVR或TAVR的所有患者。根据干预类型和临床虚弱量表，患者被分为三组：SAVR、非虚弱型TAVR和虚弱型TAVR。使用标准化死亡率（SMR）将生存率与个体水平的年龄和性别匹配的一般人群数据进行比较。
该队列包括939例SAVR患者、328例非虚弱型TAVR患者和121例虚弱型TAVR患者，平均年龄分别为73.6岁、85.3岁和85.6岁，欧洲心脏手术风险评估系统（EuroSCORE）II的中位数分别为1.9%、4.0%和5.2%。SAVR和非虚弱型TAVR患者的生存率与参考人群相当[SMR = 0.93（0.76 - 1.14）；P = 0.437和SMR = 0.94（0.76 - 1.15）；P = 0.468]。相反，与参考人群相比，虚弱型TAVR患者面临的死亡风险增加了40%[SMR = 1.40（1.04 - 1.88）；P = 0.012]。
在非虚弱患者中，TAVR和SAVR都能将预期寿命恢复到一般人群标准。对于虚弱型TAVR患者，较低的生存率凸显了虚弱对预后的重要影响，并强调了在优化患者选择以避免无效治疗方面持续存在的挑战。
