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Transcatheter Versus Surgical Aortic Valve Replacement: Propensity-Matched Comparison

Tuesday, July 18, 2017

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Source Name: Journal of the American College of Cardiology


J. Matthew Brennan, Laine Thomas, David J. Cohen, David Shahian, Alice Wang, Michael J. Mack, David R. Holmes, Fred H. Edwards, Naftali Z. Frankel, Suzanne J. Baron, John Carroll, Vinod Thourani, E. Murat Tuzcu, Suzanne V. Arnold, Roberta Cohn, Todd Maser, Brenda Schawe, Susan Strong, Allen Stickfort, Elizabeth Patrick-Lake, Felicia L. Graham, Dadi Dai, Fan Li, Roland A. Matsouaka, Sean O’Brien, Fan Li, Michael J. Pencina, Eric D. Peterson

In this large propensity-matched study, outcomes after Transcatheter versus Surgical Aortic Valve Replacement (TAVR vs. SAVR) were assessed in a real world intermediate- and high-risk cohort of 9500 patients in the United States.  There was no difference in 1-year mortality (17.3% vs. 17.9%; HR 0.93, 95% confidence interval [CI] 0.83-1.04) and stroke (4.2% vs.3.3% HR 1.18; 95% CI 0.95-1.47). Results were consistent among subgroups of patients. Importantly, there were no differences in effect across the male/female subgroups. This shows that not gender in itself, but rather gender-related comorbidities play a role in a better outcome of TAVR in female patients.  This important study shows data from daily practice and further confirms the results of randomized controlled trials. 


I am not sure what to make of this. I guess i will have to read the entire paper and look at the methodology. It sounds to me that this is a case of poor patient selection, mixing "apples and oranges" I may be wrong.....

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