Aortic and mitral valve replacement versus transcatheter aortic valve replacement in propensity-matched patients

Abstract

Background. Recent studies have suggested that transcatheteraortic valve replacement (TAVR) may have superioroutcomes compared with aortic valve replacement(AVR) for high-risk patients with significant mitralregurgitation (MR). Considering significant MR isfrequently addressed with a mitral valve repair orreplacement (MVR) at the time of open aortic valvereplacement, this study comparesTAVRandAVR/MVRinpropensity-matched pairs of patients with significant MR. Results. There was no significant difference betweenTAVR patients and AVR/MVR patients, respectively, inpreoperative average age (76 ± 7.4 versus 78 ± 6.9years, p [ 0.68), ejection fraction (53 ± 15 versus 51 ± 17,p [ 0.68), The Society of Thoracic Surgeons score(9.9 ± 3.1 versus 9.3 ± 3.4, p [ 0.61), or 30-day mortality(7.5% versus 2.5%, p [ 0.6). Postoperative MR wassignificantly improved for both TAVR and AVR/MVR,but AVR/MVR showed significantly greater improvement(L2.33 ± 1.23 versusL0.88 ± 0.79, p < 0.001). Among30-day survivors, midterm survival was significantlybetter in the AVR/MVR group compared with the TAVRgroup (log rank p [ 0.04). Methods. We evaluated all patients presenting withmoderate or greater MR undergoing either TAVR orAVR/MVR at a single institution from 2002 to 2012. Patientswho underwent other cardiac operations or hadpreoperative endocarditis were excluded. Of 306 patientsin the AVR/MVR group and 147 patients in the TAVRgroup, propensity analysis matched 40 pairs of patients.Standard univariate, logistic regression, and propensitymatching techniques were used. Conclusions. In a propensity-matched analysis of patientswith significant MR, AVR/MVR and TAVR hadequivalent perioperative outcomes, but AVR/MVR hadmore reduction in MR and may have superior midtermsurvival when compared with TAVR among 30-daysurvivors.