Robotic Aortic Valve Replacement vs Transcatheter Aortic Valve Replacement: A Propensity-Matched Analysis.

IF 3.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic Surgery Pub Date : 2024-10-30 DOI:10.1016/j.athoracsur.2024.10.013
Vikrant Jagadeesan, J Hunter Mehaffey, Ali Darehzereshki, Anas Alharbi, Mohammad Kawsara, Ramesh Daggubati, Lawrence Wei, Vinay Badhwar
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Abstract

Background: Current evidence supports equipoise between surgical aortic valve replacement (AVR) and transcatheter AVR (TAVR) for the management of symptomatic severe aortic stenosis (AS). The optimal interventional management for lower-risk patients is controversial. Minimally invasive robotic AVR (RAVR) was developed as a potential option.

Methods: A total of 605 consecutive patients (2017-2023) managed by the identical structural heart team, 174 RAVR and 431 TAVR, were propensity matched and evaluated for in-hospital and 1-year outcomes.

Results: There were 288 low- to intermediate-risk (The Society of Thoracic Surgeons predicted risk of mortality <8%) patients matched in 2 well-balanced groups (144 RAVR vs 144 TAVR). In-hospital and 30-day mortality were similar. There were 2 conversions to sternotomy in the TAVR group (cardiac arrest and coronary occlusion) and none in the RAVR group. Eight RAVR patients (5.6%) required reoperation for hemothorax evacuation. TAVR was associated with higher new pacemaker (11 vs 3, P = .028) and major vascular complications (13 vs 0, P < .0001), and a higher postprocedural stroke trend (6 vs 1, P = .056). There was no difference in 30-day transfusions, atrial fibrillation, or 1-year mean valve gradients. However, 1-year mortality (12.5% vs 1.4%, P < .0001) and paravalvular leak greater than mild (32.6% vs 2.3%, P < 0.0001) were significantly higher in TAVR.

Conclusions: These data highlight lower pacemaker and vascular complications, as well as less 1-year paravalvular leak and mortality with RAVR compared with TAVR. RAVR may provide a safe and effective minimally invasive alternative to TAVR for low- and intermediate-risk patients presenting with severe symptomatic AS.

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机器人主动脉瓣置换术与经导管主动脉瓣置换术:倾向匹配分析
背景:目前的证据表明,在治疗有症状的重度主动脉瓣狭窄(AS)时,手术瓣膜置换和 TAVR 的效果相当。对于风险较低的患者,最佳介入治疗方法还存在争议。微创机器人主动脉瓣置换术(RAVR)作为一种可能的选择被开发出来:对相同结构心脏团队管理的 605 名连续患者(2017-2023 年)、174 名 RAVR 患者和 431 名 TAVR 患者进行倾向匹配,并对院内和一年后的结果进行评估:结果:共有288名中低端风险患者(STS PROM 结论:中低端风险患者的心律失常发生率较低,而低端风险患者的心律失常发生率较高:这些数据表明,与 TAVR 相比,RAVR 的起搏器和血管并发症更低,一年的 PVL 和死亡率也更低。对于有严重症状的低中危患者,RAVR可能是TAVR的一种安全有效的微创替代方案。
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来源期刊
Annals of Thoracic Surgery
Annals of Thoracic Surgery 医学-呼吸系统
CiteScore
6.40
自引率
13.00%
发文量
1235
审稿时长
42 days
期刊介绍: The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.
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