J Yeungnam Med Sci.  2024 Apr;41(2):96-102. 10.12701/jyms.2023.01228.

Right anterior mini-thoracotomy aortic valve replacement versus transcatheter aortic valve implantation in octogenarians: a single-center retrospective study

• Im JE
• Jung EY
• Lee SS
• Min HK

• KMID: 2554770
• DOI: http://doi.org/10.12701/jyms.2023.01228

Abstract

Background
The aim of this study was to compare the early outcomes of octogenarians undergoing minimally invasive right anterior mini-thoracotomy aortic valve replacement (RAT-AVR) with those undergoing transcatheter aortic valve implantation (TAVI) for aortic valve disease.
Methods
In this single-center retrospective study, data were collected from octogenarians before and after RAT-AVR and TAVI between January 2021 and July 2022. Short-term outcomes, including the length of hospital stay, in-hospital mortality, all-cause mortality, and other major postoperative complications, were compared and analyzed.
Results
There were no significant differences in in-hospital mortality, stroke, acute kidney dysfunction requiring renal replacement therapy, length of intensive care unit stay, or length of hospital stay. However, the TAVI group had a higher incidence of permanent pacemaker insertion (10% vs. 0%, p=0.54) and paravalvular leaks (75% vs. 0%, p<0.001).
Conclusion
In the present study on octogenarians, both TAVI and RAT-AVR showed comparable short-term results. Although both procedures were considered safe and effective in the selected group, RAT-AVR had a lower incidence of complete atrioventricular block and paravalvular regurgitation.

Keyword

Minimally invasive surgical procedures; Transcatheter aortic valve implantation; Octogenarians; Aortic stenosis; Aortic valve replacement

Reference

References

1. Santarpino G, Pfeiffer S, Schmidt J, Concistrè G, Fischlein T. Sutureless aortic valve replacement: first-year single-center experience. Ann Thorac Surg. 2012; 94:504–9.

2. Miceli A, Gilmanov D, Murzi M, Marchi F, Ferrarini M, Cerillo AG, et al. Minimally invasive aortic valve replacement with a sutureless valve through a right anterior mini-thoracotomy versus transcatheter aortic valve implantation in high-risk patients. Eur J Cardiothorac Surg. 2016; 49:960–5.

3. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011; 364:2187–98.

4. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010; 363:1597–607.

5. Zahn R, Gerckens U, Grube E, Linke A, Sievert H, Eggebrecht H, et al. Transcatheter aortic valve implantation: first results from a multi-centre real-world registry. Eur Heart J. 2011; 32:198–204.

6. Solinas M, Bianchi G, Chiaramonti F, Margaryan R, Kallushi E, Gasbarri T, et al. Right anterior mini-thoracotomy and sutureless valves: the perfect marriage. Ann Cardiothorac Surg. 2020; 9:305–13.

7. Hanedan MO, Mataracı İ, Yürük MA, Özer T, Sayar U, Arslan AK, et al. Early outcomes of sutureless aortic valves. Korean J Thorac Cardiovasc Surg. 2016; 49:165–70.

8. King M, Stambulic T, Payne D, Fernandez AL, El-Diasty M. The use of sutureless and rapid-deployment aortic valve prosthesis in patients with bicuspid aortic valve: a focused review. J Card Surg. 2022; 37:3355–62.

9. Chiappini B, Camurri N, Loforte A, Di Marco L, Di Bartolomeo R, Marinelli G. Outcome after aortic valve replacement in octogenarians. Ann Thorac Surg. 2004; 78:85–9.

10. Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012; 366:1686–95.

11. Takagi H, Niwa M, Mizuno Y, Goto SN, Umemoto T; All-Literature Investigation of Cardiovascular Evidence (ALICE) Group. A meta-analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement. Ann Thorac Surg. 2013; 96:513–9.

12. Vasa-Nicotera M, Sinning JM, Chin D, Lim TK, Spyt T, Jilaihawi H, et al. Impact of paravalvular leakage on outcome in patients after transcatheter aortic valve implantation. JACC Cardiovasc Interv. 2012; 5:858–65.

13. Doyle MP, Woldendorp K, Ng M, Vallely MP, Wilson MK, Yan TD, et al. Minimally-invasive versus transcatheter aortic valve implantation: systematic review with meta-analysis of propensity-matched studies. J Thorac Dis. 2021; 13:1671–83.

14. Wang N, Tsai YC, Niles N, Tchantchaleishvili V, Di Eusanio M, Yan TD, et al. Transcatheter aortic valve implantation (TAVI) versus sutureless aortic valve replacement (SUAVR) for aortic stenosis: a systematic review and meta-analysis of matched studies. J Thorac Dis. 2016; 8:3283–93.

15. Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Søndergaard L, Mumtaz M, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2017; 376:1321–31.

16. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016; 374:1609–20.

17. Baraki H, Al Ahmad A, Jeng-Singh S, Saito S, Schmitto JD, Fleischer B, et al. Pacemaker dependency after isolated aortic valve replacement: do conductance disorders recover over time? Interact Cardiovasc Thorac Surg. 2013; 16:476–81.

18. Siontis GC, Praz F, Pilgrim T, Mavridis D, Verma S, Salanti G, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: a meta-analysis of randomized trials. Eur Heart J. 2016; 37:3503–12.

19. Nazif TM, Dizon JM, Hahn RT, Xu K, Babaliaros V, Douglas PS, et al. Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry. JACC Cardiovasc Interv. 2015; 8:60–9.

20. Indraratna P, Ang SC, Gada H, Yan TD, Manganas C, Bannon P, et al. Systematic review of the cost-effectiveness of transcatheter aortic valve implantation. J Thorac Cardiovasc Surg. 2014; 148:509–14.