Advertisement

Sutureless replacement versus transcatheter valve implantation in aortic valve stenosis: A propensity-matched analysis of 2 strategies in high-risk patients

Published:November 25, 2013DOI:https://doi.org/10.1016/j.jtcvs.2013.10.025

      Objective

      This propensity-matched study compared clinical and echocardiographic outcomes between patients undergoing transcatheter aortic valve implantation (TAVI) and sutureless aortic valve replacement.

      Methods

      From January 2010 to March 2012, 122 patients (age 79.4 ± 5.3 years, logistic euroSCORE 12% ± 8.4%) underwent minimally invasive sutureless aortic valve replacement, and 122 (age 84.6 ± 6.2 years, logistic euroSCORE 20.9% ± 2.5%) underwent TAVI. After propensity matching, 37 matched pairs were available for analysis.

      Results

      Preoperative characteristics and risk scores of matched groups were comparable. In-hospital mortalities were 0% in the sutureless group and 8.1% (n = 3) in the TAVI group (P = .24). Permanent pacemaker implantation was required in 4 patients in the sutureless group and 1 patient in the TAVI group (10.8% vs 2.7%; P = .18). A neurologic event was recorded in 2 patients of each group. Predischarge echocardiographic data showed higher paravalvular leak rate in the TAVI group (13.5% vs 0%; P = .027). At mean follow-up of 18.9 ± 10.1 months, overall cumulative survival was 91.9% and significantly differed between groups (sutureless 97.3% vs TAVI 86.5%; P = .015). In the TAVI group, a significant difference in mortality was observed between patients with (n = 20) and without (n = 17) paravalvular leak (25% vs 0%; P = .036).

      Conclusions

      Combining the advantage of standard diseased valve removal with shorter procedural times, minimally invasive sutureless aortic valve replacement may be the first-line treatment for high-risk patients considered in the “gray zone” between TAVI and conventional surgery.

      CTSNet classification

      Abbreviations and Acronyms:

      AVR (aortic valve replacement), CABG (coronary artery bypass grafting), CORONARY (Coronary Artery Bypass Surgery Off- or On-Pump Revascularization Study), PARTNER (Placement of AoRTic TraNscathetER Valve [trial]), TAVI (transcatheter aortic valve implantation), TRITON (Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve [trial])
      To read this article in full you will need to make a payment

      References

        • Vahanian A.
        • Alfieri O.
        • Andreotti F.
        • Antunes M.J.
        • Barón-Esquivias G.
        • Baumgartner H.
        • et al.
        Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).
        Eur J Cardiothorac Surg. 2012; 42: S1-S44
        • Reynolds M.R.
        • Magnuson E.A.
        • Wang K.
        • Thourani V.H.
        • Williams M.
        • Zajarias A.
        • et al.
        • PARTNER Trial Investigators
        Health-related quality of life after transcatheter or surgical aortic valve replacement in high-risk patients with severe aortic stenosis: results from the PARTNER (Placement of AoRTic TraNscathetER Valve) Trial (Cohort A).
        J Am Coll Cardiol. 2012; 60: 548-558
        • Johnston D.R.
        • Atik F.A.
        • Rajeswaran J.
        • Blackstone E.H.
        • Nowicki E.R.
        • Sabik III, J.F.
        • et al.
        Outcomes of less invasive J-incision approach to aortic valve surgery.
        J Thorac Cardiovasc Surg. 2012; 144: 852-858.e3
        • Martens S.
        • Sadowski J.
        • Eckstein F.S.
        • Bartus K.
        • Kapelak B.
        • Sievers H.H.
        • et al.
        Clinical experience with the ATS 3f Enable® Sutureless Bioprosthesis.
        Eur J Cardiothorac Surg. 2011; 40: 749-755
        • Kocher A.A.
        • Laufer G.
        • Haverich A.
        • Shrestha M.
        • Walther T.
        • Misfeld M.
        • et al.
        One-year outcomes of the Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve (TRITON) trial: a prospective multicenter study of rapid-deployment aortic valve replacement with the EDWARDS INTUITY Valve System.
        J Thorac Cardiovasc Surg. 2013; 145 (discussion 115-6): 110-115
        • Folliguet T.A.
        • Laborde F.
        • Zannis K.
        • Ghorayeb G.
        • Haverich A.
        • Shrestha M.
        Sutureless Perceval aortic valve replacement: results of two European centers.
        Ann Thorac Surg. 2012; 93: 1483-1488
        • Santarpino G.
        • Pfeiffer S.
        • Schmidt J.
        • Concistrè G.
        • Fischlein T.
        Sutureless aortic valve replacement: first-year single-center experience.
        Ann Thorac Surg. 2012; 94 (discussion 508-9): 504-508
        • Flameng W.
        • Herregods M.C.
        • Hermans H.
        • Van der Mieren G.
        • Vercalsteren M.
        • Poortmans G.
        • et al.
        Effect of sutureless implantation of the Perceval S aortic valve bioprosthesis on intraoperative and early postoperative outcomes.
        J Thorac Cardiovasc Surg. 2011; 142: 1453-1457
        • Santarpino G.
        • Pfeiffer S.
        • Fischlein T.
        Off-pump coronary artery bypass grafting in combination with transaortic transcatheter aortic valve implantation: a possible approach for patients with associated diseases.
        Int J Cardiol. 2012; 157: e7-e8
        • Zoghbi W.A.
        • Chambers J.B.
        • Dumesnil J.G.
        • Foster E.
        • Gottdiener J.S.
        • Grayburn P.A.
        • et al.
        • American Society of Echocardiography's Guidelines and Standards Committee; Task Force on Prosthetic Valves; American College of Cardiology Cardiovascular Imaging Committee; Cardiac Imaging Committee of the American Heart Association; European Association of Echocardiography; European Society of Cardiology; Japanese Society of Echocardiography; Canadian Society of Echocardiography; American College of Cardiology Foundation; American Heart Association; European Association of Echocardiography; European Society of Cardiology; Japanese Society of Echocardiography; Canadian Society of Echocardiography
        Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography.
        J Am Soc Echocardiogr. 2009; 22 (quiz 1082-4): 975-1014
        • Santarpino G.
        • Pfeiffer S.
        • Concistrè G.
        • Fischlein T.
        Perceval S aortic valve implantation in mini-invasive surgery: the simple sutureless solution.
        Interact Cardiovasc Thorac Surg. 2012; 15: 357-360
        • Walther T.
        • Möllmann H.
        • van Linden A.
        • Kempfert J.
        Transcatheter aortic valve implantation transapical: step by step.
        Semin Thorac Cardiovasc Surg. 2011; 23: 55-61
        • Willson A.
        • Toggweiler S.
        • Webb J.G.
        Transfemoral aortic valve replacement with the SAPIEN XT valve: step-by-step.
        Semin Thorac Cardiovasc Surg. 2011; 23: 51-54
        • Kodali S.K.
        • Williams M.R.
        • Smith C.R.
        • Svensson L.G.
        • Webb J.G.
        • Makkar R.R.
        • et al.
        • PARTNER Trial Investigators
        Two-year outcomes after transcatheter or surgical aortic-valve replacement.
        N Engl J Med. 2012; 366: 1686-1695
        • Sponga S.
        • Perron J.
        • Dagenais F.
        • Mohammadi S.
        • Baillot R.
        • Doyle D.
        • et al.
        Impact of residual regurgitation after aortic valve replacement.
        Eur J Cardiothorac Surg. 2012; 42: 486-492
        • D’Onofrio A.
        • Messina A.
        • Lorusso R.
        • Alfieri O.R.
        • Fusari M.
        • Rubino P.
        • et al.
        Sutureless aortic valve replacement as an alternative treatment for patients belonging to the “gray zone” between transcatheter aortic valve implantation and conventional surgery: a propensity-matched, multicenter analysis.
        J Thorac Cardiovasc Surg. 2012; 144: 1010-1016
        • Glauber M.
        • Miceli A.
        • Gilmanov D.
        • Ferrarini M.
        • Bevilacqua S.
        • Farneti P.A.
        • et al.
        Right anterior minithoracotomy versus conventional aortic valve replacement: a propensity score matched study.
        J Thorac Cardiovasc Surg. 2013; 145: 1222-1226
        • Glauber M.
        • Miceli A.
        • Bevilacqua S.
        • Farneti P.A.
        Minimally invasive aortic valve replacement via right anterior minithoracotomy: early outcomes and midterm follow-up.
        J Thorac Cardiovasc Surg. 2011; 142: 1577-1579
        • Wiegerinck E.M.
        • Cocchieri R.
        • Baan Jr., J.
        • de Mol B.A.
        Hybrid coronary artery bypass grafting and transaortic transcatheter aortic valve implantation.
        J Thorac Cardiovasc Surg. 2013; 145: 600-602
        • Unbehaun A.
        • Pasic M.
        • Dreysse S.
        • Buz S.
        • Kukucka M.
        • Hetzer R.
        • et al.
        Transcatheter aortic valve implantation and hybrid coronary artery revascularization: time to combine them.
        Innovations (Phila). 2011; 6: 395-398
        • Dewey T.M.
        • Brown D.L.
        • Herbert M.A.
        • Culica D.
        • Smith C.R.
        • Leon M.B.
        • et al.
        Effect of concomitant coronary artery disease on procedural and late outcomes of transcatheter aortic valve implantation.
        Ann Thorac Surg. 2010; 89 (discussion 767): 758-767
        • Holmes Jr., D.R.
        • Mack M.J.
        • Kaul S.
        • Agnihotri A.
        • Alexander K.P.
        • Bailey S.R.
        • et al.
        • American College of Cardiology Foundation; American Association for Thoracic Surgery; Society for Cardiovascular Angiography and Interventions; Society for Thoracic Surgeons; American Heart Association; American Society of Echocardiography; European Association for Cardio-Thoracic Surgery; Heart Failure Society of America; Mended Hearts; Society of Cardiovascular Anesthesiologists; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance
        2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement: developed in collaboration with the American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Failure Society of America, Mended Hearts, Society of Cardiovascular Anesthesiologists, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance.
        Ann Thorac Surg. 2012; 93: 1340-1395
        • Serruys P.W.
        • Morice M.C.
        • Kappetein A.P.
        • Colombo A.
        • Holmes D.R.
        • Mack M.J.
        • et al.
        • SYNTAX Investigators
        Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.
        N Engl J Med. 2009; 360: 961-972

      Linked Article

      • Sutureless valves in aortic stenosis
        The Journal of Thoracic and Cardiovascular SurgeryVol. 148Issue 1
        • Preview
          We read with interest the article by Santarpino and colleagues1 in which they compared minimally invasive aortic valve replacement with sutureless valves with transcatheter aortic valve implantation in a propensity-matched cohort of 37 patients in each group. They concluded that the advantages of sutureless valves are shorter procedural times (crossclamp time of 38.9 ± 13.7 minutes and cardiopulmonary bypass time of 68.9 ± 20.2 minutes) and less paravalvular leak relative to transcatheter aortic valve implantation.
        • Full-Text
        • PDF