Background
Methods
Inclusion/exclusion criteria
Choice of surgical vs. transcatheter aortic valve replacement
Choice of coronary revascularisation approach
Definitions
Statistical analysis
Results
Patient characteristics
SAVR + CABG | TAVR + OP/MIDCAB | TAVR + PCI | p-value (across groups) | |
---|---|---|---|---|
(n = 464) | (n = 50) | (n = 112) | ||
mean ± SD or median (IQR) or n (%)
|
mean ± SD or median (IQR) or n (%)
|
mean ± SD or median (IQR) or n (%)
| ||
Age (years) | 78.7 ± 3.1 | 82.1 ± 4.3 | 81.3 ± 5.7 | < 0.001 |
Female gender | 168 (36.2) | 19 (38.0) | 39 (34.8) | 0.923 |
BMI (kg/m2) | 26.2 ± 3.8 | 26.1 ± 4.7 | 26.0 ± 3.9 | 0.011 |
Clinical history | ||||
History of stroke/TIA | 46 (9.9) | 7 (14.0) | 16 (14.3) | 0.675 |
History of MI (< 90 days) | 138 (29.8) | 28 (56.0) | 79 (70.5) | 0.318 |
Previous cardiac surgery | 21 (4.5) | 1 (2.0) | 38 (33.9) | < 0.001 |
Diabetes mellitus | 180 (38.8) | 19 (38.0) | 33 (29.5) | 0.318 |
Hypertension | 454 (98.1) | 50 (100.0) | 109 (97.3) | 0.516 |
Pulmonary disease | 56 (12.1) | 9 (18.0) | 27 (24.1) | 0.020 |
Pulmonary hypertensiona | 128 (27.6) | 27 (54.0) | 62 (55.4) | < 0.001 |
Chronic kidney disease | ||||
Compensated | 115 (24.8) | 22 (44.0) | 49 (43.8) | < 0.001 |
Prior dialysis | 8 (1.7) | 3 (6.0) | 7 (6.3) | 0.014 |
Other valve disorders | ||||
Mitral | 235 (50.6) | 32 (64.0) | 86 (76.8) | < 0.001 |
Tricuspid | 17 (3.7) | 6 (12.0) | 12 (10.7) | < 0.001 |
EuroSCORE I (%) | 21.0 ± 17.5 | 36.4 ± 22.4 | 36.1 ± 18.9 | < 0.001 |
NYHA class | < 0.001 | |||
I/II | 206 (44.4) | 8 (16.0) | 10 (8.9) | |
III/IV | 258 (55.6) | 42 (84.0) | 102 (91.1) | |
Multi-vessel CAD | 359 (77.4) | 42 (84.0) | 83 (74.1) | 0.570 |
AV parameters | ||||
LVEF (%) | 55.7 ± 13.8 | 48.3 ± 14.4 | 51.3 ± 2.6 | < 0.001 |
EOA (cm2) | 0.8 ± 0.3 | 0.7 ± 0.2 | 0.7 ± 0.2 | < 0.001 |
Mean AV gradient (mmHg) | 40.7 ± 17.1 | 40.4 ± 14.0 | 42.5 ± 15.2 | 0.027 |
Peak AV gradient (mmHg) | 66.6 ± 25.7 | 67.9 ± 19.7 | 72.2 ± 23.3 | 0.150 |
Annulus size (cm2) | 22.9 ± 4.2 | 23.7 ± 2.2 | 22.9 ± 2.4 | 0.092 |
Peri-procedural details
SAVR + CABG | TAVR + OP/MIDCAB | TAVR + PCI | p-value (across groups) | |
---|---|---|---|---|
(n = 464) | (n = 50) | (n = 112) | ||
mean ± SD or median (IQR) or n (%)
|
mean ± SD or median (IQR) or n (%)
|
mean ± SD or median (IQR) or n (%)
| ||
Access route | < 0.001 | |||
Transfemoral | n.a. | 0 (0.0) | 41 (36.6) | |
Transapical | n.a. | 29 (58.0) | 70 (62.5) | |
Transaortic | n.a. | 21 (42.0) | 1 (0.9) | |
Prosthesis diameter (mm) | 23.7 ± 2.3 | 26.1 ± 2.1 | 25.8 ± 2.1 | < 0.001 |
23 (23–25) | 26 (26–29) | 26 (23–27) | ||
Total intervention time (min) | 221 (190–245) | 175 (146–231) | 67 (53–83) | < 0.001 |
Total length of hospital stay (d) | 12.0 (9.0–17.0) | 11.0 (7.0–20.0) | 10.0 (7.0–15.0) | 0.011 |
Length of ICU stay (d) | 1.0 (1.0–4.0) | 1.0 (1.0–4.0) | 1.0 (1.0–1.0) | 0.001 |
Erythrocyte packs/patient | 2.7 ± 3.9 | 3.6 ± 4.29 | 1.7 ± 2.9 | 0.001 |
Complications
SAVR + CABG | TAVR + OP/MIDCAB | TAVR + PCI | p-value (across groups) | |
---|---|---|---|---|
(n = 464) | (n = 50) | (n = 112) | ||
mean ± SD or median (IQR) or n (%)
|
mean ± SD or median (IQR) or n (%)
|
mean ± SD or median (IQR) or n (%)
| ||
Intra-operative mortality | 0 (0.0) | 0 (0.0) | 1 (0.9) | 0.009 |
Intra-operative resuscitation | 2 (0.4) | 2 (4.0) | 3 (2.7) | 0.017 |
Myocardial infarction | 2 (0.4) | 1 (2.0) | 0 (0.0) | 0.225 |
CK-MB (U/l) | 51.1 ± 57.1 | 47.2 ± 81.8 | 31.1 ± 35.0 | < 0.001 |
Stroke/TIA | 23 (5.0) | 1 (2.0) | 5 (4.5) | 0.622 |
Conversion to open surgerya | n.a. | 2 (4.0)b | 3 (2.7)c | 0.017 |
Re-thoracotomy | 36 (7.8) | 5 (10.0) | 3 (2.7) | 0.117 |
Pericardial tamponade | 31 (6.7) | 1 (2.0) | 1 (0.9) | 0.027 |
AKI stage II/III | 48 (10.3) | 5 (10.0) | 11 (9.8) | 0.984 |
Post-op. resuscitation (30d) | 34 (7.3) | 5 (10.0) | 6 (5.4) | 0.557 |
Post-operative dialysis (30d) | 39 (8.4) | 5 (10.0) | 14 (12.5) | 0.190 |
Permanent | 5 (1.1) | 2 (4.0) | 5 (4.5) | 0.028 |
Post-operative AF (30d) | 41 (8.8) | 3 (6.0) | 4 (3.6) | 0.154 |
Post-operative PPI (30d) | 25 (5.4) | 1 (2.0) | 11 (9.9) | 0.091 |
In-hospital mortality | 32 (6.9) | 9 (18.0) | 9 (9.0) | 0.009 |
30d overall mortality | 34 (7.4) | 8 (16.0) | 7 (6.3) | 0.077 |