Long-Term Outcomes of Conventional Aortic Valve Replacement in High-Risk Patients: Where Do We Stand?

Purpose: The introduction of transcatheter aortic valves has focused attention on the results of conventional aortic valve surgery in high-risk patients. The aim of the study was to evaluate 5-years outcomes in this category of patients in the current surgical era.Methods: This is an observational r...

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Bibliographic Details
Published in:	Annals of Thoracic and Cardiovascular Surgery Vol. 22; no. 5; pp. 304 - 311
Main Authors:	Nicolini, Francesco, Fortuna, Daniela, Contini, Giovanni Andrea, Pacini, Davide, Gabbieri, Davide, Palma, Rossana De, Gherli, Tiziano, RERIC (Registro dell’Emilia Romagna degli Interventi Cardiochirurgici) Investigators
Format:	Journal Article
Language:	English
Published:	Japan The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery 01-01-2016
Subjects:	Aged Aged, 80 and over aortic stenosis Aortic Valve - physiopathology Aortic Valve - surgery Aortic Valve Stenosis - diagnosis Aortic Valve Stenosis - mortality Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - surgery cardiac surgery Chi-Square Distribution Female Heart Valve Prosthesis Heart Valve Prosthesis Implantation - adverse effects Heart Valve Prosthesis Implantation - instrumentation Heart Valve Prosthesis Implantation - mortality heart valves Hemodynamics Humans Italy Kaplan-Meier Estimate Male Middle Aged Multivariate Analysis Original Postoperative Complications - mortality Postoperative Complications - therapy Proportional Hazards Models Registries Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome
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Summary:	Purpose: The introduction of transcatheter aortic valves has focused attention on the results of conventional aortic valve surgery in high-risk patients. The aim of the study was to evaluate 5-years outcomes in this category of patients in the current surgical era.Methods: This is an observational retrospective study of 581 high-risk patients undergoing aortic valve replacement from 2008 to 2013, with a mean logistic EuroSCORE of 26.6% ± 14.6%. Data were prospectively collected in a database of Emilia-Romagna region (Italy).Results: Overall 30-day mortality was 9.3%. Stroke rate was 1.5%. At 1-, 3-, and 5-years overall mortality was 18.2%, 30.4%, and 42.2%, cardiac death rate was 3.9%, 9.2%, and 12.9%, stroke rate 2.5%, 7.7%, and 10.2%, re-operation occurrence 0.2%, 0.9% and 1.3%, and new pacemaker implantation was 2.3%, 5.1% and 7.8%. At multivariate analysis, urgency, hemodynamic instability, LVEF ≤30%, NYHA III-IV, severe chronic obstructive pulmonary disease (COPD), extra-cardiac arteriopathy, cerebrovascular disease, and creatinine >2.0 mg/dL remained independent predictors of 5-year mortality.Conclusion: The results of the current study add weight to the evidence that traditional aortic valve replacement can be performed in high-risk patients with satisfactory 5-year mortality and morbidity. Our study may help to improve decision-making in this category of high-risk patients with aortic valve disease.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Undefined-2 E-mail: francesco.nicolini@unipr.it
ISSN:	1341-1098 2186-1005
DOI:	10.5761/atcs.oa.16-00165