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Aortic Valve Replacement In Patients 80 years old and younger. Comparison Of Mid-term Outcome between Surgical Implantation With Stentless Bio-prosthesis and Trans-cutaneous Implantation-(TAVI)
Rephael Mohr, Ariel Finkelstein, Yanai Ben-Gal, Amir Kramer, Arie Steinvil, Dmitri Pevni..
Sourasky medical center, Tel Aviv, Israel.

Aortic Valve Replacement In Patients 80 years old and younger. Comparison Of Mid-term Outcome between Surgical Implantation With Stentless Bio-prosthesis and Trans-cutaneous Implantation-(TAVI) Rephael Mohr , Ariel Finkelstein, Yanai Ben-Gal, Amir Kramer, Arie Steinvil, Dmitri Pevni. Tel Aviv Medical Center, Tel Aviv, Israel.
BACKGROUND: Most trans-cutaneous aortic valve implantation (TAVI) procedures performed today are done in patients older than 80. The purpose of these report is to compare early outcome and midterm survival of TAVI, to that of surgically implanted stentless aortic valve replacement(AVR) for patients 80 years old and younger.
METHODS: One hundred and four consecutive TAVI patients 80 years old and younger were implanted from January 2009 to May 2013. They were compared to 201 AVR patients 80 years old and younger , operated on between 1997-2013. Inclusion criteria was severe aortic stenosis (min EOA=BSAx0.85). Patients with bacterial endocarditis and patients with aortic root enlargement were excluded from the AVR group.
RESULTS: AVR patients were younger( 69+ 8 vs 76 + 14, P< 0.001.) However occurrence of female gender, peripheral vascular disease and congestive heart failure were similar. More patients in the TAVI group had chronic renal failure (CRF) (27.9% vs 9.5%, P<0.001), more had chronic obstructive lung disease (COPD) (28.8% vs 5.5%, P<0.001) and more had prior coronary artery bypass surgery (CABG) (27% vs 6%, p<0.001). Postoperatively, more patients in the TAVI group suffered stroke (12.5% vs 3.5%, p=0.003). Three years survival (Kaplan-Meier) of the AVR patients was better (95.2% vs 83.7%, p=0.016 log-rank test). Ejection fraction <= 30% and diabetes melitus were the only independent predictors of decreased survival. Assignment to TAVI or AVR was not found to be a significant risk factor for decreased survival (Cox model).
CONCLUSIONS
: Midterm outcome of AVR patients 80 years old or younger is better. However, TAVI may be considered in these patients with aortic stenosis ,especially in patients after prior CABG or patients with co-morbidities such as COPD and CRF,despite increased risk of stroke :


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