Samanidis George, Roussakis Antonios, Katsaridis Sotirios, Liaretidou Efthymia, Kefalidi Eirini, Falara Areti, Koziakas Ilias Georgios, Nenekidis Ioannis, Kosmas Ilias, Leontiadis Evangelos, Voudris Vassilios, Iakovou Ioannis, Perreas Konstantinos
Department of Cardiac Surgery, Onassis Hospital, 17674 Athens, Greece.
Department of Anesthesiology, Onassis Hospital, 17674 Athens, Greece.
J Pers Med. 2025 Aug 20;15(8):391. doi: 10.3390/jpm15080391.
The treatment of choice for aortic valve stenosis in patients with low and intermediate risk is still debated. In this study, we compared the outcomes of low-to-intermediate surgical risk patients who underwent surgical versus transcatheter aortic valve replacement for severe aortic valve stenosis (AS). Between 2015 and 2019, 326 consecutive patients with severe AS underwent transcatheter aortic valve implantation (TAVI), while 341 patients underwent surgical aortic valve replacement (SAVR). The two populations were propensity score matched by age, gender and Euroscore II. The survival rate of patients during median 5-year follow-up between SAVR and TAVI patients was evaluated. After propensity score matching, 94 pairs of patients were compared and the mean standard deviation age of patients, sex (female) and Euroscore II were 77.5 (6.6) versus 76.6 (6.5) years, 51.1% versus 51.1% and 3.3 (1.88)% versus 3.0 (1,84)%, respectively. Permanent pacemaker implantation was higher in transcatheter group (21.3% versus 1.1%, < 0.001). No difference in length of ICU and in-hospital stay was observed, = 0.08 and = 0.12, respectively. During follow-up the presence of more than moderate insufficiency of the prosthetic valve postoperatively was significantly less frequent in the surgical versus transcatheter (0% versus 14.3%). Survival rates over 1, 3 and 5 years did not differ in surgical versus transcatheter group (93.6%, 81.9% and 62.8% versus 86.2%, 69.1% and 59.6%, respectively ( = 0.16)). Short- and long-term survival rates were similar in patients who underwent transcatheter versus surgical aortic valve replacement, whereas SAVR showed superior results concerning the postoperative detection of residual regurgitation and need for PPM. It is extremely important to personalize the choice of treatment according to patients' age, clinical status and life expectancy.
低风险和中风险患者主动脉瓣狭窄的治疗选择仍存在争议。在本研究中，我们比较了接受外科手术与经导管主动脉瓣置换术治疗重度主动脉瓣狭窄（AS）的低至中手术风险患者的结局。2015年至2019年期间，326例连续的重度AS患者接受了经导管主动脉瓣植入术（TAVI），而341例患者接受了外科主动脉瓣置换术（SAVR）。根据年龄、性别和欧洲心脏手术风险评估系统（Euroscore）II对这两组人群进行倾向评分匹配。评估了SAVR组和TAVI组患者在中位5年随访期间的生存率。倾向评分匹配后，比较了94对患者，患者的平均标准差年龄、性别（女性）和Euroscore II分别为77.5（6.6）岁对76.6（6.5）岁、51.1%对51.1%、3.3（1.88）%对3.0（1.84）%。经导管组永久起搏器植入率更高（21.3%对1.1%，P<0.001）。未观察到重症监护病房（ICU）时长和住院时长的差异，P分别为0.08和0.12。随访期间，外科手术组与经导管组相比，术后人工瓣膜中度以上关闭不全的发生率显著更低（0%对14.3%）。外科手术组与经导管组1年、3年和5年的生存率无差异（分别为93.6%、81.9%和62.8%对86.2%、69.1%和59.6%，P = 0.16）。经导管主动脉瓣置换术与外科主动脉瓣置换术患者的短期和长期生存率相似，而SAVR在术后残余反流检测和永久起搏器需求方面显示出更好的结果。根据患者的年龄、临床状况和预期寿命个性化选择治疗方法极为重要。
