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Right anterior mini-thoracotomy aortic valve replacement versus transcatheter aortic valve implantation in octogenarians: a single-center retrospective study

  • Ji Eun Im (Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine) ;
  • Eun Yeung Jung (Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine) ;
  • Seok Soo Lee (Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine) ;
  • Ho-Ki Min (Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine)
  • Received : 2023.11.07
  • Accepted : 2024.01.26
  • Published : 2024.04.30

Abstract

Background: The aim of this study was to compare the early outcomes of octogenarians undergoing minimally invasive right anterior mini-thoracotomy aortic valve replacement (RAT-AVR) with those undergoing transcatheter aortic valve implantation (TAVI) for aortic valve disease. Methods: In this single-center retrospective study, data were collected from octogenarians before and after RAT-AVR and TAVI between January 2021 and July 2022. Short-term outcomes, including the length of hospital stay, in-hospital mortality, all-cause mortality, and other major postoperative complications, were compared and analyzed. Results: There were no significant differences in in-hospital mortality, stroke, acute kidney dysfunction requiring renal replacement therapy, length of intensive care unit stay, or length of hospital stay. However, the TAVI group had a higher incidence of permanent pacemaker insertion (10% vs. 0%, p=0.54) and paravalvular leaks (75% vs. 0%, p<0.001). Conclusion: In the present study on octogenarians, both TAVI and RAT-AVR showed comparable short-term results. Although both procedures were considered safe and effective in the selected group, RAT-AVR had a lower incidence of complete atrioventricular block and paravalvular regurgitation.

Keywords

References

  1. Santarpino G, Pfeiffer S, Schmidt J, Concistre G, Fischlein T. Sutureless aortic valve replacement: first-year single-center experience. Ann Thorac Surg 2012;94:504-9. https://doi.org/10.1016/j.athoracsur.2012.04.024
  2. Miceli A, Gilmanov D, Murzi M, Marchi F, Ferrarini M, Cerillo AG, et al. Minimally invasive aortic valve replacement with a sutureless valve through a right anterior mini-thoracotomy versus transcatheter aortic valve implantation in high-risk patients. Eur J Cardiothorac Surg 2016;49:960-5. https://doi.org/10.1093/ejcts/ezv210
  3. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011;364:2187-98. https://doi.org/10.1056/NEJMoa1103510
  4. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010;363:1597-607. https://doi.org/10.1056/NEJMoa1008232
  5. Zahn R, Gerckens U, Grube E, Linke A, Sievert H, Eggebrecht H, et al. Transcatheter aortic valve implantation: first results from a multi-centre real-world registry. Eur Heart J 2011;32:198-204. https://doi.org/10.1093/eurheartj/ehq339
  6. Solinas M, Bianchi G, Chiaramonti F, Margaryan R, Kallushi E, Gasbarri T, et al. Right anterior mini-thoracotomy and sutureless valves: the perfect marriage. Ann Cardiothorac Surg 2020;9:305-13. https://doi.org/10.21037/acs-2019-surd-172
  7. Hanedan MO, Mataraci I, Yuruk MA, Ozer T, Sayar U, Arslan AK, et al. Early outcomes of sutureless aortic valves. Korean J Thorac Cardiovasc Surg 2016;49:165-70. https://doi.org/10.5090/kjtcs.2016.49.3.165
  8. King M, Stambulic T, Payne D, Fernandez AL, El-Diasty M. The use of sutureless and rapid-deployment aortic valve prosthesis in patients with bicuspid aortic valve: a focused review. J Card Surg 2022;37:3355-62. https://doi.org/10.1111/jocs.16795
  9. Chiappini B, Camurri N, Loforte A, Di Marco L, Di Bartolomeo R, Marinelli G. Outcome after aortic valve replacement in octogenarians. Ann Thorac Surg 2004;78:85-9. https://doi.org/10.1016/j.athoracsur.2003.12.060
  10. Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012;366:1686-95. https://doi.org/10.1056/NEJMoa1200384
  11. Takagi H, Niwa M, Mizuno Y, Goto SN, Umemoto T; All-Literature Investigation of Cardiovascular Evidence (ALICE) Group. A meta-analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement. Ann Thorac Surg 2013;96:513-9. https://doi.org/10.1016/j.athoracsur.2013.04.049
  12. Vasa-Nicotera M, Sinning JM, Chin D, Lim TK, Spyt T, Jilaihawi H, et al. Impact of paravalvular leakage on outcome in patients after transcatheter aortic valve implantation. JACC Cardiovasc Interv 2012;5:858-65. https://doi.org/10.1016/j.jcin.2012.04.011
  13. Doyle MP, Woldendorp K, Ng M, Vallely MP, Wilson MK, Yan TD, et al. Minimally-invasive versus transcatheter aortic valve implantation: systematic review with meta-analysis of propensity-matched studies. J Thorac Dis 2021;13:1671-83. https://doi.org/10.21037/jtd-20-2233
  14. Wang N, Tsai YC, Niles N, Tchantchaleishvili V, Di Eusanio M, Yan TD, et al. Transcatheter aortic valve implantation (TAVI) versus sutureless aortic valve replacement (SUAVR) for aortic stenosis: a systematic review and meta-analysis of matched studies. J Thorac Dis 2016;8:3283-93. https://doi.org/10.21037/jtd.2016.11.100
  15. Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Sondergaard L, Mumtaz M, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med 2017;376:1321-31. https://doi.org/10.1056/NEJMoa1700456
  16. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 2016;374:1609-20. https://doi.org/10.1056/NEJMoa1514616
  17. Baraki H, Al Ahmad A, Jeng-Singh S, Saito S, Schmitto JD, Fleischer B, et al. Pacemaker dependency after isolated aortic valve replacement: do conductance disorders recover over time? Interact Cardiovasc Thorac Surg 2013;16:476-81. https://doi.org/10.1093/icvts/ivs555
  18. Siontis GC, Praz F, Pilgrim T, Mavridis D, Verma S, Salanti G, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: a meta-analysis of randomized trials. Eur Heart J 2016;37:3503-12. https://doi.org/10.1093/eurheartj/ehw225
  19. Nazif TM, Dizon JM, Hahn RT, Xu K, Babaliaros V, Douglas PS, et al. Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry. JACC Cardiovasc Interv 2015;8:60-9. https://doi.org/10.1016/j.jcin.2014.07.022
  20. Indraratna P, Ang SC, Gada H, Yan TD, Manganas C, Bannon P, et al. Systematic review of the cost-effectiveness of transcatheter aortic valve implantation. J Thorac Cardiovasc Surg 2014;148:509-14. https://doi.org/10.1016/j.jtcvs.2013.10.023