Severe aortic stenosis treated with transcatheter aortic valve implantation or surgical aortic valve replacement with Perimount in Western Denmark 2016-2022: a nationwide retrospective study

Abstract

Objectives: The healthcare registries in Denmark present a unique opportunity to gain novel insights into the outcomes associated with both transcatheter and surgical approaches to aortic valve replacement. Our objective is to enhance shared decision-making by comparing long-term mortality and clinical outcomes between treatments.

Methods: This observational study included all patients with severe aortic stenosis undergoing elective isolated transfemoral transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) in Western Denmark between January 2016 and April 2022. Patient population and clinical data were identified from the Western Danish Heart Registry and the National Danish Patient Registry, respectively. A propensity score-matched population was generated. Outcomes were investigated according to Valve Academic Research Consortium-3.

Results: A total of 2269 TAVI patients and 1094 SAVR patients where identified. The propensity score-matched population consisted of 468 TAVI patients (mean[SD]age, 75.0[5.3] years) and 468 SAVR patients (mean[SD] age, 75.1[4.6]years). The Kaplan-Meier estimate for the 5-year all-cause mortality was 29.8% in the TAVI group and 16.9% for in the SAVR group (P = 0.019). The risk of all stroke or transient ischaemic attack after five year was 15.1% in the TAVI group and 11.0% in the SAVR group (P = 0.047).

Conclusions: This study underscores the importance of evaluating all patient factors when choosing an aortic valve replacement method. Surgical aortic valve replacement was an excellent choice, especially for patients with New York Heart Association class I/II, ≥75 age, left ventricular ejection fraction ≥50%, or longer life expectancy.

Keywords: 5-year mortality; Observational; Propensity score-matched; Surgical aortic valve replacement; Transcatheter aortic valve implantation.

Graphical abstract

Figure 1:

Kaplan–Meier survival curves for different populations and method. This figure presents four distinct Kaplan–Meier survival curves each representing a specific population in separate quadrants: top-left (all patients), top-right (propensity score-matched population) and bottom-left (all patients aged 75 years and older). Red curves indicate survival following the transcatheter aortic valve implantation (TAVI) procedure, while black curves are associated with the surgical aortic valve replacement (SAVR) procedure. In the bottom-right quadrant, survival curves for specific valve types are presented: the Carpentier–Edwards Perimount (black) and the TAVI valve Edwards Sapien S3 (blue). Adjusted hazard ratios: EuroSCORE II and propensity score were utilized for adjustments in the analysis. PSM: propensity score-matched.

Figure 2:

Subgroup analysis of propensity score-matched population. Visualization of hazard rates by subgroup in propensity-matched population. NYHA: New York Heart Association; SAVR: surgical aortic valve replacement; TAVI: transcatheter aortic valve implantation. *Proportional hazard assumptions were not satisfied.

Figure 3:

Absolute risk of event in propensity score-matched population. Each quadrant represents a specific outcome: Top-left: All stroke or TIA. Top-right: Aortic valve reintervention. Bottom-left: Rehospitalization. Bottom-right: New-onset atrial fibrillation. Risks associated with the transcatheter aortic valve implantation (TAVI) procedure are denoted in red, and surgical aortic valve replacement (SAVR) procedure are in black. Solid lines illustrate the cumulative incidence according to the Aalen–Johansen estimator, and dashed lines represent the Kaplan–Meier estimator minus one (KM-1). Both the Aalen–Johansen and KM-1 estimators have been applied to each group for each specified risk. SHR: subhazard ratio; TIA: transient ischaemic attack.