Ankur Kalra1, Sajjad Raza2, Mehwish Hussain3, Khaled Shorbaji2, Sarah Delozier2, Salil V Deo2, Sahil Khera4, Neal S Kleiman5, Michael J Reardon5, Dhaval Kolte6, Tanush Gupta7, Rami Mustafa2, Deepak L Bhatt8, Joseph F Sabik9. 1. Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio. 2. Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio. 3. Cleveland Scientific Consulting, Cleveland, Ohio. 4. Structural Heart and Valve Center, Columbia University Medical Center, Manhattan, New York. 5. Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas. 6. Division of Cardiovascular Medicine, Massachusetts General Hospital, Boston, Massachusetts. 7. Division of Cardiology, Montefiore Medical Center, Bronx, New York. 8. Heart & Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts. 9. Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio. Electronic address: joseph.sabik@uhhospitals.org.
Abstract
BACKGROUND: This study was conducted to determine the current nationwide trends and outcomes of reoperative surgical aortic valve replacement (SAVR) performed for a degenerated bioprosthesis. METHODS: Data from The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were used. All patients who underwent isolated reoperative SAVR for a degenerated aortic bioprosthesis between January 2012 and December 2016 were included. Patients who had other concomitant cardiac surgery procedures or active endocarditis were excluded. Changes during this period were tracked with trend analyses. RESULTS: The number of patients undergoing SAVR for bioprosthetic failure increased substantially between 2012 and 2014 (782 in 2012 to 844 in 2013 and to 900 in 2014; relative change, +7.25%); this trend reversed significantly between 2015 and 2016 (decreased to 873 in 2015 and to 840 in 2016; relative change, -3.4%; P = .005). Patients were older in 2012-2014 (65.80 ± 13.52 years) compared with 2015-2016 (64.45 ± 12.91 years; P = .001). Mean STS-predicted mortality risk score decreased from 4.55% in 2012-2014 to 4.25% in 2015-2016 (P = .001). There was no difference in postoperative stroke (1.80% vs 1.80%, P = .87), renal failure requiring dialysis (2.7% vs 2.8%, P = .69), or operative mortality (3.5% vs 4.0%, P = .36) after reoperative SAVR in 2012-2014 and 2015-2016, respectively. CONCLUSIONS: The number of patients undergoing SAVR for a degenerated bioprosthesis is decreasing in the United States, particularly among older and high-risk patients. These trends may reflect the adoption of valve-in-valve transcatheter aortic valve replacement for a degenerated bioprosthesis after its United States Food and Drug Administration approval in 2015.
BACKGROUND: This study was conducted to determine the current nationwide trends and outcomes of reoperative surgical aortic valve replacement (SAVR) performed for a degenerated bioprosthesis. METHODS: Data from The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were used. All patients who underwent isolated reoperative SAVR for a degenerated aortic bioprosthesis between January 2012 and December 2016 were included. Patients who had other concomitant cardiac surgery procedures or active endocarditis were excluded. Changes during this period were tracked with trend analyses. RESULTS: The number of patients undergoing SAVR for bioprosthetic failure increased substantially between 2012 and 2014 (782 in 2012 to 844 in 2013 and to 900 in 2014; relative change, +7.25%); this trend reversed significantly between 2015 and 2016 (decreased to 873 in 2015 and to 840 in 2016; relative change, -3.4%; P = .005). Patients were older in 2012-2014 (65.80 ± 13.52 years) compared with 2015-2016 (64.45 ± 12.91 years; P = .001). Mean STS-predicted mortality risk score decreased from 4.55% in 2012-2014 to 4.25% in 2015-2016 (P = .001). There was no difference in postoperative stroke (1.80% vs 1.80%, P = .87), renal failure requiring dialysis (2.7% vs 2.8%, P = .69), or operative mortality (3.5% vs 4.0%, P = .36) after reoperative SAVR in 2012-2014 and 2015-2016, respectively. CONCLUSIONS: The number of patients undergoing SAVR for a degenerated bioprosthesis is decreasing in the United States, particularly among older and high-risk patients. These trends may reflect the adoption of valve-in-valve transcatheter aortic valve replacement for a degenerated bioprosthesis after its United States Food and Drug Administration approval in 2015.
Authors: Sameer A Hirji; Edward D Percy; Cheryl K Zogg; Alexandra Malarczyk; Morgan T Harloff; Farhang Yazdchi; Tsuyoshi Kaneko Journal: Eur Heart J Date: 2020-08-01 Impact factor: 29.983