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Rapid deployment aortic valve replacement versus trans-catheter aortic valve replacement in intermediate-risk patients: a propensity score analysis
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  • Jerome FERRARA,
  • Alizee Porto,
  • Pierre DEHARO,
  • Noemie RESSEGUIER,
  • nicolas jaussaud,
  • Pierre MORERA,
  • Cecile AMANATIOU,
  • Vlad GARIBOLDI,
  • Frederic COLLART,
  • Thomas CUISSET,
  • Alexis THERON
Jerome FERRARA
La Timone Hospital
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Alizee Porto
Hopital de la Timone
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Pierre DEHARO
Hôpitaux de la Timone
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Noemie RESSEGUIER
Aix-Marseille Université Faculté de Medecine
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nicolas jaussaud
La Timone Hospital
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Pierre MORERA
La Timone Hospital
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Cecile AMANATIOU
La Timone Hospital
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Vlad GARIBOLDI
La Timone Hospital
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Frederic COLLART
La Timone Hospital
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Thomas CUISSET
Hôpitaux de la Timone
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Alexis THERON
La Timone Hospital
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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.

Peer review status:Published

23 Oct 2020Submitted to Journal of Cardiac Surgery
04 Nov 2020Assigned to Editor
04 Nov 2020Submission Checks Completed
19 Nov 2020Reviewer(s) Assigned
Jan 2020Published in Archives of Cardiovascular Diseases Supplements volume 12 issue 1 on pages 90. 10.1016/j.acvdsp.2019.09.192