Outcomes comparison of different surgical strategies for the management of severe aortic valve stenosis: An Analysis from a Single Chinese Center

Objectives: In an era marked by continuous advancements in transcatheter aortic valve replacement (TAVR) technology, mitral stenosis (MS) and right minithoracotomy (RmT) remain pivotal interventions for patients.Design: Retrospective analysis.Setting: Single center in China.Participants: A total of 294 patients who underwent aortic valve replacement at Zhejiang Provincial People's Hospital between August 2018 and December 2023.Primary and Secondary Outcome Measures: The primary outcome measure is the 30-day mortality rate, with secondary outcomes encompassing various postoperative complications and procedural specifics.Results: TAVR patients exhibited significantly higher EuroScore II and APACHE II scores compared to the MS and RmT groups. Matched analysis revealed no significant differences in the 30-day mortality rate among these groups. Despite being older preoperatively, TAVR patients experienced lower rates of low cardiac output and shorter operation times compared to MS and RmT patients. However, TAVR procedures incurred notably higher total costs, and the incidence of paravalvular leak was relatively elevated in the TAVR group. Postoperatively, TAVR patients had significantly reduced drainage, indicating less postoperative bleeding. Nevertheless, the TAVR group showed higher 30-day mortality rate and an increased need for cardiopulmonary resuscitation due to clinically significant bleeding events.Conclusions: TAVR presents a viable treatment option for elderly, frail patients with multiple comorbidities who are unsuitable for traditional surgery. This approach not only substantially mitigates postoperative bleeding but also reduces hospitalization duration. However, it is important to acknowledge the higher total hospitalization costs associated with TAVR and the relatively increased incidence of paravalvular leakage.