Abstract
Background: There is insufficient evidence regarding the
comparison of Rapid Deployment aortic valve replacement(RDAVR) to TAVR
in intermediate-risk patients with severe symptomatic aortic
stenosis(AS) Aims: We compare the 2-years outcomes
between RDAVR with INTUITY and TAVR with SAPIEN 3 in intermediate-risk
patients with AS. Methods: Inclusion criteria:severe AS implanted with RDAVR or TAVR; EUROSCORE II ≥ 4% and clinical
evaluation by Heart Team. Regression adjustment for the propensity score
was used to compare RDAVR with TAVR(1:1). Primary endpoint :
composite criterion of death, disabling stroke or rehospitalization.Secondary endpoints : occurrence of major bleeding post-operative
complications, paravalvular regurgitation (PVR)≥2 and patient-prosthesis
mismatch(PPM) at 1 month and pacemaker implantation at 2 years.Results: A total of 152 patients were included from 2012
to 2018: 48 in the RDAVR group and 104 in the TAVR group. Mean age was
82.7±6, 51.3% were female, mean Euroscore II was 6.03±1.6% and mean
baseline LVEF was 56±13%,mean indexed iEOA was 0.41±0.1cm/m2, mean
gradient was 51.7±14.7mmHg. Patients with RDAVR were
younger(79.5±6vs82.6±6,p=0.01), at higher risk (EUROSCORE2
6,61±1,8%vs5,63±1,5%, p=0.005), combined surgery was performed in 28
patients(58.3%). Twenty-two patients(45.99%) met the primary outcome
in the RDAVR group and 32 patients(66.67%) in the TAVR group. By
1:1propensity score matching analysis, there was a significant
difference between both groups in favor of
RDAVR(HR=0.58[95%CI:0.34;1.00],p=0.04). No difference were observed
in PPM occurrence(0.83;[0.35-1.94];p=0.67),major bleeding
events(1.33;[0.47-3.93];p=0.59),PVR≥2(0.33[0-6.28],p=0.46), and
pacemaker implantation
(0.84[0.25-2.84],p=0.77).Conclusion: RDAVR is
associated with better 2-years outcomes than TAVR in intermediate-risk
patients with severe symptomatic AS.