Aim Compare the balloon-expandable transcatheter treatment (TAVI) with the surgical treatment [Aortic Valve Replacement (AVR)] for severe aortic valve stenosis (SAVS) in the real world clinical practice.
Materials and Methods Between 2010-2020, 1486 consecutive patients with isolated SAVS underwent AVR (n=1049) o balloon-expandable TAVI (n=437) in Hesperia Hospital Modena. In-hospital and long-term mortality in the overall population as well as cardiovascular hospital admissions in the previous 5 years and during follow-up in patients living in Emilia Romagna when AVR (n=879) and balloon-expandable TAVI (n=317) were performed, were detected.
Results TAVI population was older than AVR patients (mean age 82.2 vs. 72.7 years) and with more comorbidities. In-hospital mortality was 1.4% after AVR and 2.1% after TAVI (pNS). Five-year survival was 85.74% after AVR and 59.45% after TAVI, with TAVI as predictive factor of All-cause mortality (HR 1.44 95%CI 1.14-1.82). Five-year re-hospitalization due to Heart Failure was 20.6% after AVR and 51.3% after TAVI, with preoperative dialysis (HR 5.67 95%CI 3.06-10.49) as main predictive factor. Five-year All Stroke rate was 3.7% after AVR and 7.5% after TAVI, with preoperative atrial fibrillation as main predictive factor (HR 1.91 95%CI 1.06-3.45). Five-year Percutaneous Coronary Intervention (PCI) was 3.1% after both AVR and TAVI, with previous PCI as main predictive factor (HR 4.86 95%CI 2.57-9.21). Thirty-day pacemaker implantation rate was 2.9% after AVR and 3.4% after TAVI (pNS).
Conclusions In the real world 2010-2020 clinical practice of a single medium volume cardiac center, the balloon-expandable TAVI showed an excellent 30-day performance in comparison to the AVR, which instead provided a better performance during the follow-up.