Boston - American Association for Thoracic Surgery

AMERICAN ASSOCIATION FOR THORACIC SURGERYT3. Transcatheter Aortic Valve Replacement in High-Risk Patients:Superior Results Compared to Conventional SurgeryRobert Bauernschmitt, Domenico Mazzitelli, Christian Schreiber,Hendrik Ruge, Sabine Bleiziffer, Andrea Hutter, Peter Tassani,Ruediger Lange *Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, GermanyInvited Discussant: Joseph E. BavariaOBJECTIVE: To compare the early results of transcatheter aortic valve replacement(THV) in high-risk patients with aortic stenosis to the outcome of conventionalsurgery in a single center.METHODS: In 90 patients (mean age: 81.3 ± 7 y, 48% female, mean logistic Euro-Score 25 ± 15.6%), THV using vascular approach (femoral: 87, subclavian: 3) wasperformed between 7/2007 and 5/2008 using the 18-french-CoreValve system.Outcome data were compared to a patient cohort matched according to EuroScorevalues (mean age 78.8 ± 7.7 y, 46% female) treated by conventional surgical aorticvalve replacement (SAVR) with heart-lung machine performed by the same surgicalteam between 2001 and 2008.RESULTS: Procedural success was 98% in patients undergoing THV. Early mortality(30d) was 6.6% in THV-patients vs. 17% in the SAVR-group (p < 0.05), late mortality8.8% vs. 12%. Postoperative stroke rate was comparable in both groups (THV:5.5%, SAVR: 3%). New postoperative dialysis-dependent renal failure occurred in20% of SAVR-patients, but only in 3.3% of THV-patients. Total AV-block requiringpacemaker implantation was more frequent in the THV-group (20.7% vs. 4%), therate of postoperative myocardial infarctions was low in both groups (THV: 0,SAVR 2%).WEDNESDAYMorningCONCLUSION: Except the higher rate of total AV-blocks, the early postoperativemortality and morbidity of THV is lower as compared to SAVR. While long-termresults are still pending, we consider THV the treatment of choice in aged, highriskpatients with aortic stenosis.* AATS Member201