Comparison of transcatheter versus surgical aortic valve replacement for aortic stenosis in elderly patients
Objective To observe the oxidative stress,inflammation,myocardial injury and cardiac function changes after transcatheter aortic valve replacement(TAVR)or surgical aortic valve replacement(SAVR)in elderly patients with aortic stenosis,and to compare their efficacies and safeties.Methods From January 2020 to October 2022,165 elderly patients with aortic valve stenosis were treated in the 7th People's Hospital of Zhengzhou,among whom 92 patients received TAVR(TAVR group)and 73 patients received SAVR(SAVR group).The clinical data such as age,body mass index,and American Society of Thoracic Surgeons(STS)score were compared between two groups.The serum oxidative stress,inflammation and myocardial injury indicators before and 1 week after surgery,as well as the echocardiography cardiac function indicators before surgery,1 month after surgery and 12 months after surgery were compared.The follow-up survey was conducted for 12 months after surgery to record the occurrences of all-cause mortality,stroke,readmission due to heart failure,new-onset atrial fibrillation,new-onset conduction block,permanent pacemaker implantation,and major vascular complications in two groups.Results The patients were older in TAVR group[(70.12±6.12)years]than SAVR group[(66.71±6.23)years](t=3.527,P=0.001),the STS score was higher in TAVR group(6.42±0.81)than that in SAVR group(4.85±0.72)(t=12.980,P＜0.001),and there were no significant differences in the body mass index,NYHA cardiac function classification,comorbidities,and history of percutaneous coronary invention between two groups(P＞0.05).There were no significant differences in the levels of superoxide dismutase(SOD)[(96.24±13.21)ku/L vs.(94.15±12.30)ku/L],malonic dialdehyde(MDA)[(6.45± 1.02)μmol/L vs.(6.22±1.13)μmol/L],interleukin-1β(IL-1β)[(22.45±3.24)μg/L vs.(21.85±3.56)μg/L],tumor necrosis factor-α(TNF-α)[(46.74±6.25)ng/L vs.(45.16±6.30)ng/L],cardiac troponin T(cTnT)[(0.45± 0.12)μg/L vs.(0.42±0.14)μg/L],heat-fatty acid binding protein(H-FABP)[(0.36±0.10)mg/L vs.(0.34± 0.11)mg/L],N-terminal pro-brain natriuretic peptide(NT-proBNP)[(556.24±81.36)ng/L vs.(542.36± 80.54)ng/L]and creatine kinase isoenzyme(CK-MB)[(24.25±4.12)ku/L vs.(23.36±4.20)ku/L]before surgery between TAVR group and SAVR group(P＞0.05).One week after surgery,the serum SOD level was higher in TAVR group[(81.36±11.42)ku/L]than that in SAVR group[(75.45±10.22)ku/L](t=3.457,P=0.001),the levels of MDA,IL-1β,TNF-α,cTnT,H-FABP,NT-proBNP and CK-MB were lower in TAVR group[(7.56±1.10)μmol/L,(26.42±4.15)μg/L,(51.32±5.05)ng/L,(0.67±0.20)μg/L,(0.56±0.21)mg/L,(632.45±71.42)ng/L,(36.12±5.34)ku/L]than those in SAVR group[(8.25±1.06)μmol/L,(30.45±4.32)μg/L,(53.78±5.32)ng/L,(0.78±0.23)μg/L,(0.72±0.24)mg/L,(712.24±68.56)ng/L,(43.65±5.42)ku/L](P＜0.05).The SOD levels were lower 1 week after surgery than those before surgery in two groups(P＜0.05),and the levels of MDA,IL-1β,TNF-α,cTnT,H-FABP,NT-proBNP and CK-MB were higher than those before surgery(P＜0.05).The left ventricular ejection fractions(LVEFs),left ventricular end-diastolic dimensions(LVEDDs),mean pressure gradients(MPGs)and Vmax values showed no significant differences before and 12 months after surgery between two groups(P＞0.05).One month after surgery,LVEF was higher in TAVR group[(60.42±6.34)％]than that in SAVR group[(58.15±6.22)％](t=2.303,P=0.023),and LVEDD,MPG and Vmax were lower in TAVR group[(47.15± 6.25)mm,(11.35±2.34)mmHg,(2.15±0.42)m/s]than those in SAVR group[(49.24±6.43)mm,(12.21± 2.25)mmHg,(2.32±0.45)m/s](P＜0.05).LVEF increased sequentially in two groups before surgery,and 1 and 12 months after surgery(P＜0.05),and LVEDD,MPG and Vmax decreased sequentially(P＜0.05).The incidence of new-onset atrial fibrillation was lower in TAVR group(7.61％)than that in SAVR group(19.18％)(x2=4.905,P=0.027),the incidence of new-onset conduction block and permanent pacemaker implantation rate were higher in TAVR group(27.17％,10.87％)than those in SAVR group(9.59％,2.74％)(x2=8.051,P=0.005;x2=3.989,P=0.046),and there were no significant difference in the incidence rates of all-cause mortality,stroke,readmission due to heart failure and major vascular complications between two groups(P＞0.05).Conclusion TAVR can alleviate early postoperative oxidative stress,inflammation and myocardial injury,and improve heart function compared with SAVR,and it has similar efficacy to SAVR one year after surgery in elderly patients with severe aortic stenosis,but it would increase the incidence of new-onset conduction block and permanent pacemaker implantation rate.
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