ArticleInterdisciplinary cardiovascular and thoracic surgery2026
Transcatheter Versus Minimally Invasive Surgical Aortic Valve Replacement With Rapid-Deployment Valves: A Propensity-Matched Analysis.
Article in Interdisciplinary cardiovascular and thoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThis 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.
methodsAll 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.
resultsFrom 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).
conclusionsMinimally 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.
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