Outcomes for Low-Risk Surgical Aortic Valve Replacement: A Benchmark for Aortic Valve Technology

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d3386084e201">Background</h5> <p id="P1">Two large, randomized trials are underway evaluating transcatheter aortic valve replacement (TAVR) against conventional surgical aortic valve replacement (AVR). We analyzed contemporary, real-world outcomes of surgical aortic valve replacement in low-risk patients to provide a practical benchmark of outcomes and cost for evaluating current and future TAVR technology. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d3386084e206">Methods</h5> <p id="P2">From 2010 to 2015, 2,505 isolated AVR operations were performed for severe aortic stenosis (AS) at 18 statewide cardiac institutions. Of these, 2,138 patients had a STS predicted risk of mortality (PROM) less than 4%, and 1,119 met other clinical and hemodynamic criteria as outlined in the PARTNER 3 protocol. Patients with endocarditis, end stage renal disease, EF&lt;45%, bicuspid valves and previous valve replacements were excluded. Outcomes of interest included operative mortality and postoperative adverse events. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d3386084e211">Results</h5> <p id="P3">The median STS PROM for the study eligible patients was 1.44%, with a median age of 72 (IQR 65–78). Operative mortality was 1.3%, permanent stroke was 1.3%, and pacemaker requirement was 4.2%. The most common adverse events were transfusion of 2 or more units of red blood cells (18%) and atrial fibrillation (28%). The median length of stay was 6 days (IQR 5–8). Median total hospital cost was $37,999 (IQR $30,671–$46,138). Examination of complications by age&lt;65 vs. ≥65 demonstrated significantly lower need for transfusion (11.2%, p&lt;0.001) and atrial fibrillation (17.1%, p&lt;0.001), but no difference in operative mortality (2.2% vs 0.9%, p =0.1), major morbidity (10.4% vs 12.6%, p=0.3), or total hospital costs. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d3386084e216">Conclusions</h5> <p id="P4">In the current era, low risk patients undergoing surgical AVR have excellent results. The most common complications were atrial fibrillation and bleeding. These real-world results should provide additional context for upcoming transcatheter clinical trial data. </p> </div>