AORTIC VALVE REPLACEMENT VERSUS BALLOON EXPANDABLE AND SELF EXPANDABLE TRANSCATHETER AORTIC VALVE IMPLANTATION IN LOW-RISK PATIENTS

Background and Aim: in patients with symptomatic aortic stenosis, TAVI has emerged as an attractive alternative to surgery. However, TAVI carries an increased risk of conduction abnormalities and para-valvular leak (PVL) which may generate some concerns with the extension of TAVI indication to patients with longer life-expectancy. The aim of this study is to compare post-procedural outcomes and 5-year survival of low-risk patients who underwent SAVR vs balloon expandable (BE) or self expandable (SE) TAVI Methods: 542 patients, undergoing SAVR (n=221), BE TAVI (n=150) or SE TAVI (n= 171), from 09/2017 to 12/2022 were enrolled. Elegible patients were aged between 70 and 85 years with low surgical risk and isolated severe AS. The primary end-point was 5-year all cause mortality. To compare patients with similar baseline characteristics a propensity score matching was performed Results: before matching, TAVI patients were older and with a higher Euroscore II. SAVR patients showed a significantly higher incidence of post-procedural AKI, whereas SE patients had a higher incidence of conduction abnormalities, stroke and PVL than surgical and BE TAVI patients. After matching, surgical and BE TAVI patients showed a lower incidence of stoke (2,3%-0%vs6,3%, p=0,045), LBBB (0/18,2%vs25%, p<0,001) and PVL (0/2,4%vs8,1%, p=0,017) when compared to SE TAVI. 5-year mortality was significantly higher in SE TAVI patients when compared to surgical patients, while no significant difference was reported between BE TAVI and SAVR patients. Conclusion: BE prosthesis should be considered the prosthesis of choice for patients with long life-expectancy requiring a transcatheter procedure.