eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
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4/2020
vol. 16
 
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Cardiac surgery
abstract:
Clinical research

Early and late outcomes after transcatheter versus surgical aortic valve replacement in obese patients

Giovanni Mariscalco
1, 2
,
Paola D’Errigo
3
,
Fausto Biancari
4, 5, 6
,
Stefano Rosato
3
,
Francesco Musumeci
7
,
Marco Barbanti
8
,
Marco Ranucci
9
,
Gennaro Santoro
10
,
Gabriella Badoni
3
,
Danilo Fusco
11
,
Martina Ventura
11
,
Corrado Tamburino
8
,
Fulvia Seccareccia
3

1.
Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
2.
Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
3.
Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
4.
Heart Center, Turku University Hospital, Turku, Finland
5.
Department of Surgery, University of Turku, Turku, Finland
6.
Department of Surgery, University of Oulu, Oulu, Finland
7.
Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy
8.
Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
9.
Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
10.
Ospedale Careggi di Firenze, Florence, Italy
11.
Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
Arch Med Sci 2020; 16 (4): 796–801
Online publish date: 2019/05/21
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Introduction
Data on the early and late outcome following transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in obese patients are limited. We investigated whether TAVI may be superior to SAVR in obese patients.

Material and methods
Obese patients (body mass index ≥ 30 kg/m2) who underwent either SAVR or TAVI were identified from the nationwide OBSERVANT registry, and their in-hospital and long-term outcomes were analysed. Propensity score matching was employed to identify two cohorts with similar baseline characteristics.

Results
The propensity score matching provided 142 pairs balanced in terms of baseline risk factors. In-hospital and 30-day mortality did not differ between SAVR and TAVI obese patients (4.6% vs. 3.3%, p = 0.56, and 5.2% vs. 3.2%, p = 0.41, respectively). Obese SAVR patients experienced a higher rate of renal failure (12.4% vs. 3.6%, p = 0.0105) and blood transfusion requirement (60.3% vs. 25.7%, p < 0.0001) in comparison with TAVI patients. A higher rate of permanent pacemaker implantation (14.4% vs. 3.6%, p = 0.0018), and major vascular injuries (7.4% vs. 0%, p = 0.0044) occurred in the TAVI group. Five-year survival was higher in the SAVR group compared to the TAVI patient cohort (p = 0.0046), with survival estimates at 1, 3 and 5 years of 88.0%, 80.3%, 71.8% for patients undergoing SAVR, and 85.2%, 69.0%, 52.8% for those subjected to TAVI procedures.

Conclusions
In obese patients, both SAVR and TAVI are valid treatment options, although in the long term SAVR exhibited higher survival rates.

keywords:

transcatheter aortic valve implantation, aortic valve replacement, obesity, mortality

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