Aortic Valve Replacement via Ministernotomy versus Transcatheter Aortic Valve Implantation in Intermediate Risk Patients: Propensity Score Analysis

Background: Transcatheter aortic valve implantation (TAVI) is an established method in inoperable and high-risk patients. The extent to which the findings from this patient collective are relevant to patients with only an intermediate risk is unclear. Against this background, we investigated periprocedural outcome, as well as mid-term survival in all patients who underwent aortic valve replacement (AVR) via ministernotomy, transapical or transfemoral TAVI at our hospital.

Methods: A prospective register was taken from a single-center recording all aortic valve replacements via ministernotomy (MIC, n = 1,177), transapical (TA, n = 363) and transfemoral (TF, n = 507) aortic valve implantations during the period from July 2009 to October 2014. Propensity score matching was performed based on 24 preoperative risk factors.

Results: We were able to find 92 triplets, MIC versus TA versus TF at moderate risk (EuroScore II 3.5 vs. 3.5 vs. 3.2; STS 4.4 vs. 4.7 vs. 4.6). In the comparison there were no significant periprocedural differences regarding 30d mortality, stroke or myocardial infarction. Regarding mid-term survival, the TA procedure showed a tendency toward a less favorable outcome.

Conclusion: The periprocedural results between MIC, TA and TF are comparable in patients at intermediate surgical risk. The tendency in the TA group toward a less favorable survival outcome could be due to an additional confounding factor, e.g., frailty, for which we were unable to perform adjustments in this analysis. Long-term data from randomized studies are required to exclude a tendency toward a less favorable survival outcome for TAVI compared with MIC-AVR in patients at intermediate-risk.