Comparative Analysis of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Frail Elderly Patients: A Multicenter Cohort Study

Abstract

Background: Aortic stenosis (AS) is a common valvular heart disease affecting the elderly, with Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) being the primary treatments. Frail elderly patients are often at high risk for complications with SAVR, making TAVI a potential alternative. Objective: To compare the clinical outcomes of TAVI and SAVR in frail elderly patients with severe aortic stenosis. Methods: This multicenter cohort study included 168 frail elderly patients with severe AS, treated at Yale School of Medicine from January 2020 to June 2022. Patients were divided into two groups: TAVI (n=84) and SAVR (n=84). Primary endpoints included all-cause mortality, stroke, and functional recovery, with secondary outcomes assessing hospital readmissions and reoperation rates. Statistical analyses were performed using SPSS (version 26.0), and p-values were calculated for comparisons between groups. Standard deviation was used to assess variability in outcomes. Results: At the 12-month follow-up, TAVI patients had a 5% lower mortality rate compared to SAVR (6.7% vs 11.7%), with a p-value of 0.03. Stroke rates were similar (TAVI: 2.4%, SAVR: 3.2%). Hospital readmissions were significantly lower for TAVI patients (15%) compared to SAVR (27%) (p<0.05). Standard deviation of recovery time was 3.2 days for TAVI and 4.5 days for SAVR, indicating quicker recovery for TAVI. Reoperation rates were significantly higher for SAVR (4.8%) compared to TAVI (1.2%). Conclusion: TAVI demonstrated superior short-term outcomes compared to SAVR in frail elderly patients with aortic stenosis, with lower mortality, faster recovery, and fewer reoperations.