Suciu Horațiu, Elkahlout Ayman, Nicolae Viorel, Tomșa Flavius, Stan Alexandru, Al-Hussein Hussam, Călburean Paul-Adrian, Scurtu Anda-Cristina, Aniței David Emanuel, Hadadi László, Brînzaniuc Klara, Harpa Marius Mihai
Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania.
Department of Cardiovascular Surgery, Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania.
J Cardiovasc Dev Dis. 2025 Jun 7;12(6):217. doi: 10.3390/jcdd12060217.
The aim of this study was to compare costs and clinical outcomes associated with transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR). A secondary analysis was performed in patients with coronary artery disease, and patients with TAVI and percutaneous coronary intervention (PCI) were compared with SAVR and coronary artery bypass grafting (CABG). All patients who underwent the TAVI or SAVR procedure for severe degenerative aortic stenosis between August 2013 and February 2025 at a tertiary cardiovascular center were selected for inclusion in the present study. Patients were excluded if there was no available follow-up or if there was a crossover between treatments (especially CABG undergoing TAVI or SAVR undergoing PCI within a 6-month timeframe). A total of 2452 patients (1925 undergoing SAVR and 527 undergoing TAVI) were included. Of those, 400 underwent SAVR + CABG and 75 underwent TAVI + PCI. During a median follow-up of 2.88 (1.12-6.43) years, a total of 404 all-cause events occurred, corresponding to 4.18 deaths per 100 patient-years. TAVI was associated with higher hospitalization costs and fewer in-hospital deaths than SAVR. However, long-term survival was similar between TAVI and SAVR and between TAVI + PCI and SAVR + CABG. Interventional treatment was more cost-effective in patients with EuroSCORE > 10%, while surgical treatment was more cost-effective in patients with EuroSCORE < 10%. In patients who are at high surgical risk, TAVI is more cost-effective than SAVR, and TAVI + PCI is more cost-effective than SAVR + CABG. In patients who are not at high surgical risk, SAVR is more cost-effective than TAVI, and SAVR + CABG is more cost-effective than TAVI + PCI.
本研究的目的是比较经导管主动脉瓣植入术（TAVI）与外科主动脉瓣置换术（SAVR）的成本及临床结局。对冠心病患者进行了二次分析，并将接受TAVI和经皮冠状动脉介入治疗（PCI）的患者与接受SAVR和冠状动脉旁路移植术（CABG）的患者进行了比较。选取2013年8月至2025年2月在一家三级心血管中心因严重退行性主动脉瓣狭窄接受TAVI或SAVR手术的所有患者纳入本研究。如果没有可用的随访数据或存在治疗交叉（特别是在6个月时间内接受CABG的患者接受TAVI或接受PCI的患者接受SAVR），则将患者排除。共纳入2452例患者（1925例接受SAVR，527例接受TAVI）。其中，400例接受SAVR + CABG，75例接受TAVI + PCI。在中位随访2.88（1.12 - 6.43）年期间，共发生404例全因事件，相当于每100患者年有4.18例死亡。与SAVR相比，TAVI的住院费用更高，住院死亡人数更少。然而，TAVI与SAVR之间以及TAVI + PCI与SAVR + CABG之间的长期生存率相似。对于欧洲心脏手术风险评估系统（EuroSCORE）> 10%的患者，介入治疗更具成本效益，而对于EuroSCORE < 10%的患者，手术治疗更具成本效益。在手术风险高的患者中，TAVI比SAVR更具成本效益，TAVI + PCI比SAVR + CABG更具成本效益。在手术风险不高的患者中，SAVR比TAVI更具成本效益，SAVR + CABG比TAVI + PCI更具成本效益。
