Transapical versus Conventional Aortic Valve Replacement—A Propensity-Matched Comparison


  • David M. Holzhey
  • William Shi
  • A. Rastan
  • Michael A. Borger
  • Martin Hänsig
  • Friedrich W. Mohr



Introduction: The goal of this study was to compare the short- and long-term outcomes after aortic valve (AV) surgery carried out via standard sternotomy/partial sternotomy versus transapical transcatheter AV implantation (taTAVI).

Patients and Methods: All 336 patients who underwent taTAVI between 2006 and 2010 were compared with 4533 patients who underwent conventional AV replacement (AVR) operations between 2001 and 2010. Using propensity score matching, we identified and consecutively compared 2 very similar groups of 167 patients each. The focus was on periprocedural complications and long-term survival.

Results: The 30-day mortality rate was 10.8% and 8.4% (P = .56) for the conventional AVR patients and the TAVI patients, respectively. The percentages of postoperative pacemaker implantations (15.0% versus 6.0%, P = .017) and cases of renal failure requiring dialysis (25.7% versus 12.6%, P = .004) were higher in the TAVI group. Kaplan-Meier curves diverged after half a year in favor of conventional surgery. The estimated 3-year survival rates were 53.5% ± 5.7% (TAVI) and 66.7% ± 0.2% (conventional AVR).

Conclusion: Our study shows that even with all the latest successes in catheter-based AV implantation, the conventional surgical approach is still a very good treatment option with excellent long-term results, even for older, high-risk patients.


Aktug O, Dohmen G, Brehmer K, et al. 2011. Incidence and predictors of left bundle branch block after transcatheter aortic valve implantation. Int J Cardiol. In press.nAustin PC. 2007. Propensity-score matching in the cardiovascular surgery literature from 2004 to 2006: a systematic review and suggestions for improvement. J Thorac Cardiovasc Surg 134:1128-35.nBuellesfeld L, Gerckens U, Schuler G, et al. 2011. 2-Year follow-up of patients undergoing transcatheter aortic valve implantation using a self-expanding valve prosthesis. J Am Coll Cardiol 57:1650-7.nDrews T, Pasic M, Buz S, et al. 2011. Transcranial Doppler sound detection of cerebral microembolism during transapical aortic valve implantation. Thorac Cardiovasc Surg 59:237-42.nEwe SH, Delgado V, Ng AC, et al. 2011. Outcomes after transcatheter aortic valve implantation: transfemoral versus transapical approach. Ann Thorac Surg. In press.nGeorge JC, Varghese V, Dangas G, Popma JJ. 2011. Transcatheter aortic valve implantation: lessons from the PARTNER (Placement of Aortic Transcatheter Valves) trial. JACC Cardiovasc Interv 4:132-3.nGhanem A, Muller A, Nahle CP, et al. 2010. Risk and fate of cerebral embolism after transfemoral aortic valve implantation: a prospective pilot study with diffusion-weighted magnetic resonance imaging. J Am Coll Cardiol 55:1427-32.nGotzmann M, Bojara W, Lindstaedt M, et al. 2011. One-year results of transcatheter aortic valve implantation in severe symptomatic aortic valve stenosis. Am J Cardiol 107:1687-92.nJohansson M, Nozohoor S, Kimblad PO, Harnek J, Olivecrona GK, Sjögren J. 2011. Transapical versus transfemoral aortic valve implantation: a comparison of survival and safety. Ann Thorac Surg 91:57-63.nKoos R, Mahnken AH, Aktug O, et al. 2011. Electrocardiographic and imaging predictors for permanent pacemaker requirement after transcatheter aortic valve implantation. J Heart Valve Dis 20:83-90.nNuis RJ, van Mieghem NM, Boon RM, et al. 2011. Effect of experience on results of transcatheter aortic valve implantation using a Medtronic CoreValve System. Am J Cardiol 107:1824-9.nSmith CR, Leon MB, Mack MJ, et al. 2011. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364:2187-98.nVahanian A, Alfieri O, Al-Attar N, et al. 2008. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 29:1463-70.nWalther T, Schuler G, Borger MA, et al. 2010. Transapical aortic valve implantation in 100 consecutive patients: comparison to propensity-matched conventional aortic valve replacement. Eur Heart J 31:1398-403.nWalther T, Dewey T, Borger MA, et al. 2009. Transapical aortic valve implantation: step by step. Ann Thorac Surg 87:276-83.n



How to Cite

Holzhey, D. M., Shi, W., Rastan, A., Borger, M. A., Hänsig, M., & Mohr, F. W. (2012). Transapical versus Conventional Aortic Valve Replacement—A Propensity-Matched Comparison. The Heart Surgery Forum, 15(1), E4-E8.