Selection for Transcatheter versus Surgical Aortic Valve Replacement and Long-term Survival: 10-year Results of the AUTHEARTVISIT Study

Background Limited data are available from randomized trials comparing outcomes between transcatheter aortic valve replacement (TAVR) and surgery in patients with different risks and with follow-up >2 years. Objective In this large, population-based cohort study, long-term mortality and morbidity were investigated in patients undergoing aortic valve replacement (AVR) for severe aortic stenosis using a surgically implanted bioprosthesis (sB-AVR) or TAVR. Methods Individual data from the Austrian Insurance funds from 2010 through 2020 were analysed. The primary outcome was all-cause mortality, assessed in the overall and propensity score–matched populations. Secondary outcomes included reoperation and cardiovascular events. Results From January 2010 through December 2020, a total of 18 882 patients underwent sB-AVR (n=11 749; 62.2%) or TAVR (n=7133; 37.8%); median follow-up was 4.0 (interquartile range 2.1–6.5) years (maximum 12.3 years). The risk of all-cause mortality was higher with TAVR compared with sB-AVR: hazard ratio (HR) 1.552, 95% confidence interval (CI) 1.469–1.640, p<0.001; propensity score–matched HR 1.510, 1.403–1.625, p<0.001. Estimated median survival was 8.8 years (95% CI 8.6–9.1) with sB-AVR vs 5 years (4.9–5.2) with TAVR. Estimated 5-year survival probability was 0.664 (0.664–0.686) with sB-AVR vs 0.409 (0.378–0.444) with TAVR overall, and 0.690 (0.674–0.707) and 0.560 (0.540–0.582), respectively, with propensity score matching. Other predictors of mortality were age, sex, previous heart failure, diabetes, and chronic kidney disease. Conclusions In >2-year follow-up, selection for TAVR was significantly associated with higher all-cause mortality compared with sB-AVR in patients ≥65 years with severe, symptomatic aortic stenosis..

Medienart:	Preprint

Erscheinungsjahr:	2023
Erschienen:	2023

Enthalten in:	Preprints.org - (2023) vom: 03. Juli Zur Gesamtaufnahme - year:2023

Sprache:	Englisch

Beteiligte Personen:	Auer, Johann [VerfasserIn] Krotka, Pavla [VerfasserIn] Reichard, Berthold [VerfasserIn] Traxler, Denise [VerfasserIn] Wendt, Ralph [VerfasserIn] Mildner, Michael [VerfasserIn] Ankersmit, Hendrik Jan [VerfasserIn] Graf, Alexandra [VerfasserIn]

Links:	Volltext [kostenfrei]

doi:	10.20944/preprints202306.2155.v1

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PPN (Katalog-ID):	preprintsorg040063372