Rapid deployment aortic valve replacement versus trans-catheter aortic
valve replacement in intermediate-risk patients: a propensity score
analysis
Abstract
Background: There is insufficient evidence regarding the comparison of
Rapid Deployment aortic valve replacement(RDAVR) to TAVR in
intermediate-risk patients with severe symptomatic aortic stenosis(AS)
Aims: We compare the 2-years outcomes between RDAVR with INTUITY and
TAVR with SAPIEN 3 in intermediate-risk patients with AS. Methods:
Inclusion criteria: severe AS implanted with RDAVR or TAVR; EUROSCORE II
≥ 4% and clinical evaluation by Heart Team. Regression adjustment for
the propensity score was used to compare RDAVR with TAVR(1:1). Primary
endpoint: composite criterion of death, disabling stroke or
rehospitalization. Secondary endpoints: occurrence of major bleeding
post-operative complications, paravalvular regurgitation (PVR)≥2 and
patient-prosthesis mismatch(PPM) at 1 month and pacemaker implantation
at 2 years. Results: A total of 152 patients were included from 2012 to
2018: 48 in the RDAVR group and 104 in the TAVR group. Mean age was
82.7±6, 51.3% were female, mean Euroscore II was 6.03±1.6% and mean
baseline LVEF was 56±13%,mean indexed iEOA was 0.41±0.1cm/m2, mean
gradient was 51.7±14.7mmHg. Patients with RDAVR were
younger(79.5±6vs82.6±6,p=0.01), at higher risk (EUROSCORE2
6,61±1,8%vs5,63±1,5%, p=0.005), combined surgery was performed in 28
patients(58.3%). Twenty-two patients(45.99%) met the primary outcome
in the RDAVR group and 32 patients(66.67%) in the TAVR group. By
1:1propensity score matching analysis, there was a significant
difference between both groups in favor of
RDAVR(HR=0.58[95%CI:0.34;1.00],p=0.04). No difference were observed
in PPM occurrence(0.83;[0.35-1.94];p=0.67),major bleeding
events(1.33;[0.47-3.93];p=0.59),PVR≥2(0.33[0-6.28],p=0.46), and
pacemaker implantation (0.84[0.25-2.84],p=0.77).Conclusion: RDAVR is
associated with better 2-years outcomes than TAVR in intermediate-risk
patients with severe symptomatic AS.