Transcatheter aortic valve implantation versus surgery: 4-year survival according to life expectancy.

Background: In the last years, transcatheter aortic valve implantation (TAVI) indication has expanded to younger and lower risk patients. Consequently, interest in mid and long-term follow up and in the role of life expectancy, as a key factor for selecting the most tailored treatment, has grown. The aim of this retrospective study is to compare the 4-year survival of patients who underwent aortic valve replacement (AVR) . TAVI at our department.

Methods: From September 2017 to December 2020, 673 consecutive patients with severe aortic valve stenosis were enrolled for AVR ( = 283) or TAVI ( = 390). Inclusion criteria was isolated severe aortic stenosis, while exclusion criteria were redo surgery, valve-in-valve procedure and the need for concomitant surgical procedures. Based on the Lee index, patients were divided into four groups according to their 4-year life expectancy. Four-year survival was assessed and reported using the Kaplan-Meier method. A multivariate regression analysis of risk factors for 4-year mortality was performed.

Results: Four years survival is always superior in the AVR patients (89.8% 75.6%, < 0.001). Surgery is associated with a higher incidence of acute kidney injury (23% 5.1%, < 0.001), while TAVI is related to a higher incidence of new onset left bundle branch block (0 23.8%, < 0.001), pace-maker implantation (2.5% 11.8%, = 0,02) and mild-to-moderate paravalvular leak (0.3% 5.4%, < 0.001). The independent risk factors for 4-years mortality are post-procedural AKI, poor mobility and transcatheter procedure.

Conclusion: In our analysis, 4 years survival is always superior in the AVR patients. Life expectancy is a key factor for selecting the most appropriate approach for each patient. A longer follow up is mandatory before extending TAVI indication to patients with a long-life expectancy.