摘要
Background In the last years,transcatheter aortic valve implantation(TAVI)indication has expanded to younger and lower risk patients.Consequently,interest in mid and long-term follow up and in the role of life expectancy,as a key factor for selecting the most tailored treatment,has grown.The aim of this retrospective study is to compare the 4-year survival of patients who underwent aortic valve replacement(AVR)vs.TAVI at our department.Methods From September 2017 to December 2020,673 consecutive patients with severe aortic valve stenosis were enrolled for AVR(n=283)or TAVI(n=390).Inclusion criteria was isolated severe aortic stenosis,while exclusion criteria were redo surgery,valve-in-valve procedure and the need for concomitant surgical procedures.Based on the Lee index,patients were divided into four groups according to their 4-year life expectancy.Four-year survival was assessed and reported using the Kaplan-Meier method.A multivariate regression analysis of risk factors for 4-year mortality was performed.Results Four years survival is always superior in the AVR patients(89.8%vs.75.6%,P<0.001).Surgery is associated with a higher incidence of acute kidney injury(23%vs.5.1%,P<0.001),while TAVI is related to a higher incidence of new onset left bundle branch block(0 vs.23.8%,P<0.001),pace-maker implantation(2.5%vs.11.8%,P=0,02)and mild-to-moderate paravalvular leak(0.3%vs.5.4%,P<0.001).The independent risk factors for 4-years mortality are post-procedural AKI,poor mobility and transcatheter procedure.Conclusion In our analysis,4 years survival is always superior in the AVR patients.Life expectancy is a key factor for selecting the most appropriate approach for each patient.A longer follow up is mandatory before extending TAVI indication to patients with a long-life expectancy.
