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ORIGINAL ARTICLE
Year : 2019  |  Volume : 32  |  Issue : 2  |  Page : 604-609

Transcatheter aortic valve implantation versus surgical replacement in high-risk patients with aortic stenosis


1 Department of Cardiothoracic Surgery, Faculty of Medicine, Menoufia University, Shibin El-Kom, Egypt
2 Department of Cardiac Surgery, National Heart Institute, Giza, Egypt

Correspondence Address:
Ahmed M Fekry
Al Amal Street, 8th District, Sheikh Zayed City 41516, Giza
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_879_17

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Objectives The aim of this study was to demonstrate whether transcatheter aortic valve implantation (TAVI) improves mortality and morbidity compared with surgical aortic valve replacement in high-risk patients who require intervention for aortic valve stenosis (AS). Many patients with severe AS and coexisting conditions are not candidates for surgical replacement of the aortic valve. Recently, TAVI has been suggested as a less invasive treatment for high-risk patients with AS. Patients and methods Fifty patients with severe AS for aortic valve intervention were classified as follows: group A, as TAVI group, included 25 patients who underwent aortic valve replacement by transcatheter femoral approach, and group B, as surgical aortic valve replacement group, included 25 patients who underwent aortic valve replacement by median sternotomy. Results Intraoperatively, procedure duration was 101.8 ± 10.6 and 191.2 ± 7.5 min in group A and B, respectively (P < 0.001). Major vascular complications occurred in 20% of patients in group A and 0% of patients in group B (P = 0.018). Postoperative follow-up mean ICU stay was 3 ± 2.4 and 4.8 ± 3.5 days in groups A and B, respectively (P = 0.035). In group A, 32% of patients needed permanent pacemaker. In group A, 12% of patients developed stroke or transient ischemic attacks. Paravalvular aortic regurgitation occurred in 36.3 and 4.5% of patients in groups A and B, respectively (P = 0.009). Conclusion In high-risk patients with severe AS, transcatheter and surgical procedures for aortic valve replacement were comparable for survival at 3 months, although there were important differences in periprocedural outcomes.


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