Only about half of the patients with symptomatic severe aortic stenosis will survive a few years longer without invasive treatment. Transcatheter aortic valve implantation has increasingly been used during recent years. However, it is important to have more data about the usefulness of transcatheter treatment compared to surgery in different patient groups.
Introduction of transcatheter aortic valve implantation has led to a paradigm shift in the treatment of severe aortic stenosis during the past decade. Based on the evidence, the transcatheter method is used especially in patients at increased risk for surgical aortic valve replacement. However, there has been insufficient data comparing transcatheter and surgical treatment in low-risk patient groups.
The aim of this study was to compare the 3–4-year outcomes of patients who were at low-risk for surgery and who underwent transcatheter or surgical treatment for aortic stenosis. The main finding was that the estimated survival was similar in both treatment groups. Secondly, the study compared the safety measures. Similar rates of operative mortality were observed in the transcatheter and surgical cohorts. Surgical treatment was associated with more severe bleeding and atrial fibrillation, but on the other hand with less major vascular injury and valve regurgitation compared to transcatheter aortic valve implantation.
The findings of this study are based on a nationwide FinnValve study carried out in collaboration between cardiothoracic surgery and cardiology units in all Finnish university hospitals. Data on all patients who underwent transcatheter valve implantation or surgical valve replacement with a bioprosthesis for severe aortic stenosis were retrospectively collected in the registry from 2008 to 2017. The results of this dissertation comparing transcatheter and surgical treatment are based on the use of a propensity score matching of low-risk patient cohorts.
“The study supports the view that even in patients at low risk of surgery, a similar prognosis can be achieved after transcatheter and surgical treatment in the next few years”, Marko Virtanen says.
The transcatheter method and surgical treatment both involve typical risks per procedure. This information can be used to consider the treatment modality for aortic stenosis. The optimal choice of treatment for a low-risk patient can best be made in collaboration between cardiologists and cardiac surgeons.
The doctoral dissertation of Licentiate of Medicine Marko Virtanen in the field of cardiology titled Treatment of Severe Aortic Stenosis with a Transcatheter or Surgical Bioprosthesis: Results from the FinnValve Registry will be publicly examined in the Faculty of Medicine and Health Technology at Tampere University in the auditorium F115 of the Arvo building, Arvo Ylpön katu 34, Tampere, on 21 May 2021, at 12 o’clock. The Opponent will be Docent Heikki Miettinen from University of Eastern Finland. Professor Kjell Nikus will act as the custos.
The event can be followed via remote connection.
The dissertation is available online at
Photo: Helka Virtanen