Early clinical outcomes after transapical aortic valve implantation: A propensity-matched comparison with conventional aortic valve replacement

Objective: Aortic valve replacement remains the standard treatment for symptomatic severe aortic stenosis. However, catheter-based approaches have recently emerged as therapeutic options for high-risk surgical candidates. The objective of this study is to use propensity scoring to compare early clinical outcomes after transapical aortic valve implantation and conventional aortic valve replacement. Method: Propensity scoring based on logistic regression modeling of 16 preoperative patient characteristics was used to identify a group of very high-risk patients undergoing isolated conventional aortic valve replacement comparable to those patients undergoing transapical aortic valve implantation. McNemar's test was used to compare early clinical outcomes between the 2 treatment groups, including 30-day mortality and in-hospital postoperative complications. Results: Ninety-two patients receiving transapical aortic valve implantation between October 2005 and April 2010 met inclusion criteria for this study. Half of these patients were successfully matched 1:1 to a patient receiving conventional aortic valve replacement. Baseline characteristics were similar between the 2 treatment groups after propensity matching. There were 4 perioperative deaths (8.7%) in the conventional aortic valve replacement group and 6 perioperative deaths (13%) in the transapical aortic valve implantation group (P > .05). There were no significant differences in the rates of cerebrovascular accidents, wound infections, reoperation for bleeding, or length of postoperative hospital stay between the 2 groups (P > .05). Conclusions: Among high-risk propensity-matched patients, early clinical outcomes are similar after transapical aortic valve implantation and conventional aortic valve replacement. However, given the likelihood of residual selection bias, a prospective randomized trial is necessary to adequately compare the clinical outcomes after these 2 aortic valve procedures. (J Thorac Cardiovasc Surg 2011;142:e47-52)