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Contemporary Real-World Outcomes of Surgical Aortic Valve Replacement in 141,905 Low-Risk, Intermediate-Risk, and High-Risk Patients

The Annals of thoracic surgery, 2015-01, Vol.99 (1), p.55-61 [Peer Reviewed Journal]

The Society of Thoracic Surgeons ;2015 The Society of Thoracic Surgeons ;Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. ;ISSN: 0003-4975 ;EISSN: 1552-6259 ;DOI: 10.1016/j.athoracsur.2014.06.050 ;PMID: 25442986

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Title:
Contemporary Real-World Outcomes of Surgical Aortic Valve Replacement in 141,905 Low-Risk, Intermediate-Risk, and High-Risk Patients
Author: Thourani, Vinod H., MD ; Suri, Rakesh M., MD, DPhil ; Gunter, Rebecca L., MD ; Sheng, Shubin, PhD ; O’Brien, Sean M., PhD ; Ailawadi, Gorav, MD ; Szeto, Wilson Y., MD ; Dewey, Todd M., MD ; Guyton, Robert A., MD ; Bavaria, Joseph E., MD ; Babaliaros, Vasilis, MD ; Gammie, James S., MD ; Svensson, Lars, MD, PhD ; Williams, Mathew, MD ; Badhwar, Vinay, MD ; Mack, Michael J., MD
Subjects: Aged ; Aortic Valve Insufficiency - surgery ; Aortic Valve Stenosis - surgery ; Cardiothoracic Surgery ; Female ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Surgery ; Treatment Outcome
Is Part Of: The Annals of thoracic surgery, 2015-01, Vol.99 (1), p.55-61
Description: Background The introduction of transcatheter aortic valve replacement mandates attention to outcomes after surgical aortic valve replacement (SAVR) in low-risk, intermediate-risk, and very high-risk patients. Methods The study population included 141,905 patients who underwent isolated primary SAVR from 2002 to 2010. Patients were risk-stratified by Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) <4% (group 1, n = 113,377), 4% to 8% (group 2, n = 19,769), and >8% (group 3, n = 8,759). The majority of patients were considered at low risk (80%), and only 6.2% were categorized as being at high risk. Outcomes were analyzed based on two time periods: 2002 to 2006 (n = 63,754) and 2007 to 2010 (n = 78,151). Results The mean age was 65 years in group 1, 77 in group 2, and 77 in group 3 ( p < 0.0001). The median STS PROM for the entire population was 1.84: 1.46% in group 1, 5.24% in group 2, and 11.2% in group 3 ( p < 0.0001). Compared with PROM, in-hospital mean mortality was lower than expected in all patients (2.5% vs 2.95%) and when analyzed within risk groups was as follows: group 1 (1.4% vs 1.7%), group 2 (5.1% vs 5.5%), and group 3 (11.8% vs 13.7%) ( p < 0.0001). In the most recent surgical era, operative mortality was significantly reduced in group 2 (5.4% vs 6.4%, p = 0.002) and group 3 (11.9% vs 14.4%, p = 0.0004) but not in group 1. Conclusions Nearly 80% of patients undergoing SAVR have outcomes that are superior to those by the predicted risk models. In the most recent era, early results have further improved in medium-risk and high-risk patients. This large real-world assessment serves as a benchmark for patients with aortic valve stenosis as therapeutic options are further evaluated.
Publisher: Netherlands: Elsevier Inc
Language: English
Identifier: ISSN: 0003-4975
EISSN: 1552-6259
DOI: 10.1016/j.athoracsur.2014.06.050
PMID: 25442986
Source: GFMER Free Medical Journals
MEDLINE
Alma/SFX Local Collection

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Contemporary Real-World Outcomes of Surgical Aortic Valve Replacement in 141,905 Low-Risk, Intermediate-Risk, and High-Risk Patients

The Society of Thoracic Surgeons ;2015 The Society of Thoracic Surgeons ;Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. ;ISSN: 0003-4975 ;EISSN: 1552-6259 ;DOI: 10.1016/j.athoracsur.2014.06.050 ;PMID: 25442986

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