# Transcatheter Versus Minimally Invasive Surgical Aortic Valve Replacement With Rapid-Deployment Valves: A Propensity-Matched Analysis

## TL;DR

This study compares two heart valve replacement methods and finds that minimally invasive surgery may lead to better survival and fewer complications than a catheter-based approach.

## Contribution

The study introduces a propensity-matched comparison of MI-SAVR and TF-TAVR using rapid-deployment valves in low-risk patients.

## Key findings

- MI-SAVR had 0% operative mortality compared to 3.3% in TF-TAVR.
- MI-SAVR showed significantly lower rates of paravalvular leakage and new pacemaker implantations.
- Survival at 3 years was higher in MI-SAVR (88%) than in TF-TAVR (67%).

## Abstract

This study evaluates intermediate-term survival and valve-related complications in patients undergoing minimally invasive surgical aortic valve replacement (MI-SAVR) using rapid-deployment (RD) valves compared with those receiving transfemoral transcatheter aortic valve replacement (TF-TAVR) after propensity-matched analysis.

All consecutive patients treated with either isolated MI-SAVR with an RD valve or TF-TAVR at a single cardiac-surgery centre were retrospectively reviewed. A propensity score was created, and exact matching was applied after the maximum propensity score difference. Nearest-neighbour matching was conducted with a caliper of 0.2 standard deviations of the logit of the propensity score, without replacement and with a 1:1 matching ratio.

From April 2011 to June 2022, 926 patients underwent either isolated MI-SAVR with an RD valve (n = 400) or TF-TAVR (n = 526). After propensity score matching, the final cohort (n = 366) included 183 matched pairs. Operative mortality was 0% after MI-SAVR compared with 3.3% (n = 6) following TF-TAVR (P = .03). Perioperative stroke occurred in 2.7% (n = 5, MI-SAVR) vs 2.2% (n = 4, TF-TAVR, P = 1). At 3 years, MI-SAVR was associated with significantly lower rates of paravalvular leakage (2.2% vs 13.8%, P < .001), new pacemaker implantations (6.6% vs 14.8%, P = .01) and a composite end-point of thromboembolic and major bleeding events (7.2% vs 12.7%, P = .025). No difference between aortic valve re-interventions and stroke was identified between groups. Survival at 1- and 3-year follow-up was 98% and 88% (MI-SAVR) and 88% and 67% (TF-TAVR) respectively (P < .001). EuroScore II emerged as an independent predictor of mortality (HR 1.12 [1.02, 1.23], P = .014).

Minimally invasive SAVR with RD-valves could represent a treatment modality to TF-TAVR for severe AS in an older, low-risk patient cohort. In our retrospective cohort study, MI-SAVR was linked to improved survival and lower rates of permanent pacemaker implantation and paravalvular leakage.

European guidelines recommend transfemoral transcatheter aortic valve replacement (TF-TAVR) for patients with severe aortic stenosis (AS) above the age of 70 years, irrespective of surgical risk.