When Real-World Outcomes Do Not Meet the Results of Clinical Trials: Transfemoral Transcatheter vs. Surgical Aortic Valve Replacement in an Intermediate-Age Population (The Outstanding Italy Study)

<b>Objective</b>: Aortic valve stenosis is the most common valvular heart disease in the elderly, and its treatment may be either surgical (SAVR) or transcatheter (TAVI). Although age is one of the main determinants of the therapeutic choice, current guidelines leave a "discrepancy area" between 65 and 75 years, with the American guidelines allowing TAVI for patients older than 65 years, while the European guidelines consider TAVI for patients older than 75 years. The present study addresses the outcomes of SAVR vs. TAVI in a real-world population aged 65 to 80 years, that is, one largely inclusive of the discrepancy area. <b>Methods</b>: This is a retrospective registry study based on data retrieved from administrative health databases of two large Italian regions (Lombardy and Puglia). Patients aged 65 to 80 years receiving either SAVR or a TAVI between 2018 and 2021 were selected. SAVR and TAVI outcomes (death, cardiac and non-cardiac events) were compared using a propensity-matching analysis, with a follow-up of 2 to 5 years and mortality as the primary outcome. <b>Results</b>: After propensity matching, two groups of 786 patients were compared in Lombardy and two groups of 321 patients were compared in Puglia. In both regions, at the end of follow-up, mortality was significantly (<i>p</i> < 0.001) lower in SAVR vs. TAVI (24.6% vs. 47.2% in Lombardy and 18.1% vs. 44.1% in Puglia). <b>Conclusions</b>: Our results are in contrast with the randomized controlled trials showing equivalence or even the superiority of TAVI vs. SAVR, but in agreement with other registry studies based on real-world data. With respect to the randomized controlled trials, the main difference is a better outcome in SAVR. Caution should be applied in addressing patients < 80 years with TAVI unless SAVR is contraindicated.

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Publication Details

Journal
Journal of Clinical Medicine
Published
2025-05-15
DOI
https://doi.org/10.3390/jcm14103471
Citations
1
Primary Topic
Cardiac Valve Diseases and Treatments
Type
article
Field-Weighted Citation Impact
1.39

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article

When Real-World Outcomes Do Not Meet the Results of Clinical Trials: Transfemoral Transcatheter vs. Surgical Aortic Valve Replacement in an Intermediate-Age Population (The Outstanding Italy Study)

Eloisa Arbustini, Lorenzo Menicanti, Fabio Robusto, Antonio Clavenna et al.
1 citations
Journal of Clinical Medicine
Cardiac Valve Diseases and Treatments
1.39
article

When Real-World Outcomes Do Not Meet the Results of Clinical Trials: Transfemoral Transcatheter vs. Surgical Aortic Valve Replacement in an Intermediate-Age Population (The Outstanding Italy Study)

Eloisa Arbustini, Lorenzo Menicanti, Fabio Robusto, Antonio Clavenna, Marco Ranucci, Maria Teresa La Rovere, Gianfranco Parati, Vito Lepore, Lucia Bisceglia, Matteo Montorfano, Roberto Latini, Maurizio Volterrani, Francesco Santini, A D'Ettorre, Giuseppe Maria Raffa, Lidia Staszewsky, Roberto F.E. Pedretti, Massimo Cartabia, Giulio Stefanini, Damiano Baldassarre, Mauro Tettamanti, Ida Fortino
article en
1 citations

Abstract

<b>Objective</b>: Aortic valve stenosis is the most common valvular heart disease in the elderly, and its treatment may be either surgical (SAVR) or transcatheter (TAVI). Although age is one of the main determinants of the therapeutic choice, current guidelines leave a "discrepancy area" between 65 and 75 years, with the American guidelines allowing TAVI for patients older than 65 years, while the European guidelines consider TAVI for patients older than 75 years. The present study addresses the outcomes of SAVR vs. TAVI in a real-world population aged 65 to 80 years, that is, one largely inclusive of the discrepancy area. <b>Methods</b>: This is a retrospective registry study based on data retrieved from administrative health databases of two large Italian regions (Lombardy and Puglia). Patients aged 65 to 80 years receiving either SAVR or a TAVI between 2018 and 2021 were selected. SAVR and TAVI outcomes (death, cardiac and non-cardiac events) were compared using a propensity-matching analysis, with a follow-up of 2 to 5 years and mortality as the primary outcome. <b>Results</b>: After propensity matching, two groups of 786 patients were compared in Lombardy and two groups of 321 patients were compared in Puglia. In both regions, at the end of follow-up, mortality was significantly (<i>p</i> < 0.001) lower in SAVR vs. TAVI (24.6% vs. 47.2% in Lombardy and 18.1% vs. 44.1% in Puglia). <b>Conclusions</b>: Our results are in contrast with the randomized controlled trials showing equivalence or even the superiority of TAVI vs. SAVR, but in agreement with other registry studies based on real-world data. With respect to the randomized controlled trials, the main difference is a better outcome in SAVR. Caution should be applied in addressing patients < 80 years with TAVI unless SAVR is contraindicated.

Journal of Clinical MedicineVol. 14(10)
Vita-Salute San Raffaele University (IT), University of Milan (IT), Mario Negri Institute for Pharmacological Research (IT), San Raffaele University of Rome (IT), Centro Cardiologico Monzino (IT), Istituti Clinici Scientifici Maugeri (IT), MultiMedica (IT), IRCCS Policlinico San Donato (IT), Agenzia Regionale Sanitaria della Puglia (IT), IRCCS Istituto Auxologico Italiano (IT), Ospedale Policlinico San Martino (IT), Policlinico San Matteo Fondazione (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), IRCCS Humanitas Research Hospital (IT), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IT), University of Milano-Bicocca (IT), University of Genoa (IT), University of Palermo (IT)
Ministero della Salute
Good health and well-being
Openalex Percentile: Top 19%
Cardiac Valve Diseases and Treatments
1.39
DOIOpen Access PDFOpenAlex
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