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Transcatheter and surgical aortic valve replacement in patients with left ventricular dysfunction |
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| Author: | Jalava, Maina P.1; Savontaus, Mikko1; Ahvenvaara, Tuomas2; |
| Organizations: |
1Heart Centre, Turku University Hospital and University of Turku, P. O. Box 52, 20521, Turku, Finland 2Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland 3Heart Center, Helsinki University Hospital, Helsinki, Finland
4Heart Hospital, Tampere University Hospital and University of Tampere, Tampere, Finland
5Department of Internal Medicine, Oulu University Hospital, Oulu, Finland 6Heart Center, Kuopio University Hospital, Kuopio, Finland 7National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy 8Clinica Montevergine, GVM Care and Research, Mercogliano, Italy |
| Format: | article |
| Version: | published version |
| Access: | open |
| Online Access: | PDF Full Text (PDF, 1.2 MB) |
| Persistent link: | http://urn.fi/urn:nbn:fi-fe2023062965898 |
| Language: | English |
| Published: |
Springer Nature,
2022
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| Publish Date: | 2023-06-29 |
| Description: |
AbstractBackground: Patients with severe aortic stenosis and left ventricular systolic dysfunction have a poor prognosis, and this may result in inferior survival also after aortic valve replacement. The outcomes of transcatheter and surgical aortic valve replacement were investigated in this comparative analysis. Methods: The retrospective nationwide FinnValve registry included data on patients who underwent transcatheter or surgical aortic valve replacement with a bioprosthesis for severe aortic stenosis. Propensity score matching was performed to adjust the outcomes for baseline covariates of patients with reduced (≤ 50%) left ventricular ejection fraction. Results: Within the unselected, consecutive 6463 patients included in the registry, the prevalence of reduced ejection fraction was 20.8% (876 patients) in the surgical cohort and 27.7% (452 patients) in the transcatheter cohort. Reduced left ventricular ejection fraction was associated with decreased survival (adjusted hazards ratio 1.215, 95%CI 1.067–1.385) after a mean follow-up of 3.6 years. Among 255 propensity score matched pairs, 30-day mortality was 3.1% after transcatheter and 7.8% after surgical intervention (p = 0.038). One-year and 4-year survival were 87.5% and 65.9% after transcatheter intervention and 83.9% and 69.6% after surgical intervention (restricted mean survival time ratio, 1.002, 95%CI 0.929–1.080, p = 0.964), respectively. Conclusions: Reduced left ventricular ejection fraction was associated with increased morbidity and mortality after surgical and transcatheter aortic valve replacement. Thirty-day mortality was higher after surgery, but intermediate-term survival was comparable to transcatheter intervention. Trial registration: The FinnValve registry ClinicalTrials.gov Identifier: NCT03385915. see all
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| Series: |
Journal of cardiothoracic surgery |
| ISSN: | 1749-8090 |
| ISSN-E: | 1749-8090 |
| ISSN-L: | 1749-8090 |
| Volume: | 17 |
| Issue: | 1 |
| Article number: | 322 |
| DOI: | 10.1186/s13019-022-02061-9 |
| OADOI: | https://oadoi.org/10.1186/s13019-022-02061-9 |
| Type of Publication: |
A1 Journal article – refereed |
| Field of Science: |
312 Clinical medicine |
| Subjects: | |
| Funding: |
This work was supported by the Department of Clinical Medicine University of Turku, the Finnish Foundation for Cardiovascular Research and the Finnish Cultural Foundation. The FinnValve trial is carried out without funding. |
| Copyright information: |
© The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
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https://creativecommons.org/licenses/by/4.0/ |