Minimal-invasive Behandlungen der Aortenklappenstenose: eine aktuelle Vergleichsanalyse
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Philipps-Universität Marburg
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Abstract
Background: Current studies equate TAVI with SAVR for medium and high risk patients across the board. Yet a study comparing transfemoral transcatheter aortic valve implantation (TF-TAVI) to SAVR via upper mini-sternotomy (PUMS-SAVR) has not been validated.
This study aims to take a closer look at clinical outcomes including mortality and in-hospital morbidity in patients suffering from aortic valve stenosis and having received treatment either via TF-TAVI or PUMS-SAVR as well as their postprocedural quality of life within the scope of a pilot study.
Methods: Baseline, procedural and post-treatment data of 197 consecutive patients were retrospectively collected, 137 TF-TAVI and 60 PUMS-SAVR patients treated at our institution. The propensity score method was used to create two groups in a 1:1 fashion. Health-related quality of life (HrQoL) assessment was carried out at the out-patient routine control presentation for select patients via SF-36 questionnaire and evaluated using a specifically defined categorisiation as well as the RAND 36-Item Health Survey Scoring System.
Results: After propensity matching, TF-TAVI remained associated with lower
procedural time (136 ± 50 vs. 298 ± 36 min, p > 0.01), shorter intensive care unit stay (2.68 ± 2.70 vs. 4.29 ± 2.43 days, p > 0.01), fewer transfusions of packed red cell units (0.46 ± 2.05 vs. 1.60 ± 2.00 IU, p = 0.02) as well as higher heart block (42.9 % vs. 0 %, p < 0.01) and permanent pacemaker implantation rates (17.1 % vs. 0 %, p < 0.05) compared to PUMS-SAVR.
PUMS-SAVR is associated with better postprocedural HRQoL, particularly regarding physical functioning (TAVI 43,75 pts vs. MIC-AKE 78,13 pts, p < 0,01), role limitations due to physical health (TAVI 26,67 pts vs. MIC-AKE 56,25 pts, p < 0,01) and levels of energy/fatigue (TAVI 39 pts vs. MIC-AKE 54,69 pts, p < 0,05).
Conclusions: Although PUMS-SAVR offers a better technical outcome with lower rates of permanent pacemaker implantation and less paravalvular leakage than TF-TAVI, it is still associated with a higher need for transfusion, as well as longer ventilation times and intensive care unit stays.
Patients who received treatment via PUMS-SAVR presented higher levels of postprocedural HRQoL throughout all evaluated categories, proving the necessity for further examination regarding the comparison between PUMS-SAVR and TF-TAVI.
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Created: 2024Issued: 2025-01-08Updated: 2025-01-08
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
TF-TAVIaortic valve stenosisminimally invasiveSAVRministernotomyPUMS-SAVRquality of lifeHRQoLTAVI
DFG-subjects
TF-TAVIminimalinvasivSAVRTAVIMIC-AKEAortenklappenstenoseMinisternotomieLebensqualität
DDC-Numbers
610
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Glück, Alannah: Minimal-invasive Behandlungen der Aortenklappenstenose: eine aktuelle Vergleichsanalyse. : Philipps-Universität Marburg 2025-01-08. DOI: https://doi.org/10.17192/z2024.0393.
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This item has been published with the following license: In Copyright