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TAVI vs SAVR in the elderly: a multivariate survival analysis
Session:
CO 14 - Prémio Manuel Machado Macedo
Speaker:
Pedro Lamares Magro
Congress:
CPC 2018
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.2 Cardiovascular Surgery – Valves
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Pedro Lamares Magro; Rui Campante Teles; Manuel Almeida; Tiago Nolasco; João Brito; Pedro de Araújo Gonçalves; Regina Ribeiras; Sérgio Boshoff; José Calquinha; Miguel Sousa Uva; José Pedro Neves
Abstract
<p>Introduction</p> <p>Transcatheter aortic valve implantation (TAVI) has changed the paradigm of aortic valve stenosis (AVS) intervention demonstrating both safety and efficacy in high risk, and more recently, in intermediate risk patients. In light of these results, some clinicians believe TAVI is the preferable approach to all patients over 80 years. The objective of this study is to compare the mid-term survival of TAVI and surgical aortic valve replacement (SAVR) in patients older than 80 years.</p> <p>Methods</p> <p>This is a retrospective observational single-center intent-to-treat study including all older than 80 years patients submitted to single aortic valve replacement (SAVR and TAVI) at our institution between November 2008 and November 2016, including all routes and prosthetic devices.</p> <p>Mid-term survival was evaluated using unadjusted (Kaplan-Meier), multivariate (Cox hazard modeling) and compared with expected standard population survival (one sample log rank test).</p> <p>Results:</p> <p>Our cohort included 458 patients (SAVR=241; TAVI=217) with a mean age at intervention of 84±3 (SAVR= 83±2; TAVI= 86±3; p<0,001). Compared to SAVR patients, TAVI presented a higher prevalence of comorbidities such as previous surgery, extracardiac vasculopathy, CAD, low ejection fraction; NYHA III/IV and higher Euroscore II risk, all P<0,05. Unadjusted survival with a mean follow-up of 40±29 months was similar (log rank test, p=0,075). Multivariate analysis of survival identified renal disease (HR 1,7; p=0,24), extracardiac vasculopathy (HR 1,7; p=0,24) and low ejection fraction (HR 2,3; p=0,28) as significant predictors of survival. When comparing the survival of patients exposed to both treatments to that of the general population matched for age and gender, both treatments presented higher mid-term survival (p<0,001). </p> <p>Conclusion</p> <p>After adjusting for various risk factors SARV demonstrated similar mid-term survival when compared to TAVI, suggesting that both techniques continue to be a valid option. AVS treatment choice in the elderly should be tailored according to the patient profile and part of a multidisciplinary team decision, rather than elderly state.</p> <p> </p> <p> </p>
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