scholarly journals Cause of Death After Surgical Aortic Valve Replacement: SWEDEHEART Observational Study

2021 ◽  
Author(s):  
Natalie Glaser ◽  
Michael Persson ◽  
Anders Franco‐Cereceda ◽  
Ulrik Sartipy
Keyword(s):  
Aortic Valve ◽  
General Population ◽  
Life Expectancy ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Causes Of Death ◽  
Study Cohort ◽  
Surgical Aortic Valve Replacement ◽  
Standardized Mortality Ratios

Background Prior studies showed that life expectancy in patients who underwent surgical aortic valve replacement (AVR) was lower than in the general population. Explanations for this shorter life expectancy are unknown. The aim of this nationwide, observational cohort study was to investigate the cause‐specific death following surgical AVR. Methods and Results We included 33 018 patients who underwent primary surgical AVR in Sweden between 1997 and 2018, with or without coronary artery bypass grafting. The SWEDEHEART (Swedish Web‐System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) register and other national health‐data registers were used to obtain and characterize the study cohort and to identify causes of death, categorized as cardiovascular mortality, cancer mortality, or other causes of death. The relative risks for cause‐specific mortality in patients who underwent AVR compared with the general population are presented as standardized mortality ratios. During a mean follow‐up period of 7.3 years (maximum 22.0 years), 14 237 (43%) patients died. The cumulative incidence of death from cardiovascular, cancer‐related, or other causes was 23.5%, 8.3%, and 11.6%, respectively, at 10 years, and 42.8%, 12.8%, and 23.8%, respectively, at 20 years. Standardized mortality ratios for cardiovascular, cancer‐related, and other causes of death were 1.79 (95% CI, 1.75–1.83), 1.00 (95% CI, 0.97–1.04), and 1.08 (95% CI, 1.05–1.12), respectively. Conclusions We found that life expectancy following AVR was lower than in the general population. Lower survival after AVR was explained by an increased relative risk of cardiovascular death. Future studies should focus on the role of earlier surgery in patients with asymptomatic aortic stenosis and on optimizing treatment and follow‐up after AVR. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02276950.

scholarly journals Indications and predictors for pacemaker implantation after isolated aortic valve replacement with bioprostheses: the CAREAVR study

2020 ◽  
Vol 31 (3) ◽  
pp. 398-404
Author(s):  
Samuli J Salmi ◽  
Tuomo Nieminen ◽  
Juha Hartikainen ◽  
Fausto Biancari ◽  
Joonas Lehto ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Atrioventricular Block ◽  
Sick Sinus Syndrome ◽  
Pacemaker Implantation ◽  
Left Ventricular Ejection ◽  
Surgical Aortic Valve Replacement

Abstract OBJECTIVES We sought to study the indications, long-term occurrence, and predictors of permanent pacemaker implantation (PPI) after isolated surgical aortic valve replacement with bioprostheses. METHODS The CAREAVR study included 704 patients (385 females, 54.7%) without a preoperative PPI (mean ± standard deviation age 75 ± 7 years) undergoing isolated surgical aortic valve replacement at 4 Finnish hospitals between 2002 and 2014. Data were extracted from electronic patient records. RESULTS The follow-up was median 4.7 years (range 1 day to 12.3 years). Altogether 56 patients received PPI postoperatively, with the median 507 days from the operation (range 6 days to 10.0 years). The PPI indications were atrioventricular block (31 patients, 55%) and sick sinus syndrome (21 patients, 37.5%). For 4 patients, the PPI indication remained unknown. A competing risks regression analysis (Fine–Gray method), adjusted with age, sex, diabetes, coronary artery disease, preoperative atrial fibrillation (AF), left ventricular ejection fraction, New York Heart Association class, AF at discharge and urgency of operation, was used to assess risk factors for PPI. Only AF at discharge (subdistribution hazard ratio 4.34, 95% confidence interval 2.34–8.03) was a predictor for a PPI. CONCLUSIONS Though atrioventricular block is the major indication for PPI after surgical aortic valve replacement, >30% of PPIs are implanted due to sick sinus syndrome during both short-term follow-up and long-term follow-up. Postoperative AF versus sinus rhythm conveys >4-fold risk of PPI. Clinical trial registration clinicaltrials.gov Identifier: NCT02626871

scholarly journals Life Expectancy After Surgical Aortic Valve Replacement

2021 ◽  
Vol 78 (22) ◽  
pp. 2147-2157 ◽  
Author(s):  
Andreas Martinsson ◽  
Susanne J. Nielsen ◽  
Milan Milojevic ◽  
Björn Redfors ◽  
Elmir Omerovic ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Life Expectancy ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Surgical Aortic Valve Replacement

scholarly journals Severe aortic stenosis in octogenarian: is surgical aortic valve replacement a good option?

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
R Menezes Fernandes ◽  
HA Costa ◽  
JS Bispo ◽  
TF Mota ◽  
D Bento ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Older Patients ◽  
Independent Predictor ◽  
Advanced Age ◽  
Surgical Aortic Valve Replacement ◽  
Predictors Of Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Aortic stenosis (AS) is the most prevalent valvular heart disease among the elderly, reaching 8,1% in 85 years-old patients. Symptomatic severe AS entails a high risk of morbidity and mortality without valve replacement, and increasing age is associated with higher surgical risk. Purpose To determine the prognostic impact of advanced age in patients with severe AS referred to surgical valve replacement. Methods We conducted a retrospective study encompassing patients referred to surgical aortic valve replacement due to severe AS, from January 2016 to December 2018. Clinical characteristics, diagnostic studies and follow-up were analysed. Patients were divided in two groups according to the age: <80 and ≥80 years old. Independent predictors of mortality and/or re-hospitalization were identified through a binary logistic regression analysis, considering p = 0,05. Results A total of 222 patients were included, with a 64,4% male predominance and a median age of 75 years old. 27,5% had concomitant surgical coronary artery disease and 87,4% waited in an out-patient setting. Median delay until surgery was 87 days and median follow-up after surgical referral was 517 days. 59 patients (26,8%) had ≥ 80 years old. Male gender (69,6% vs 50,8%; p = 0,01), smoking habits (14,3% vs 1,7%; p = 0,024), higher glomerular filtration rate (75,5 vs 63,2 ml/min; p = 0,001) and lower Euroscore II values (2,89% vs 4,64%; p = 0,003) were more common in younger patients. Global mortality rate (27,1% vs 15,5%; p = 0,05) and the composite of mortality or re-hospitalization (52,5% vs 36,6%; p = 0,034) were more frequent in older patients. Despite re-hospitalizations were also more common (37,3% vs 29,2%), they did not reach statistical significance (p = 0,252). After multivariate analysis, advanced age was not an independent predictor of mortality and/or re-hospitalization. In this population, only the presence of extracardiac arteriopathy (p = 0,007; p = 0,006) and pulmonary hypertension (p = 0,004; p = 0,002) were both independent predictors of mortality and the composite of mortality or re-hospitalization. Conclusion Older patients with AS have higher mortality, but advanced age was not an independent predictor of mortality and/or re-hospitalization. The decision to perform aortic valve replacement should be discussed in the Heart Team, considering patient’s comorbidities and performing a comprehensive geriatric evaluation, not just focusing on age itself.

scholarly journals Comparative survival and role of STS score in aortic paravalvular leak after SAVR or TAVR: a retrospective study from the USA

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022437 ◽  
Author(s):  
Ratnasari Padang ◽  
Mahmoud Ali ◽  
Kevin L Greason ◽  
Christopher G Scott ◽  
Manasawee Indrabhinduwat ◽  
...  
Keyword(s):  
Overall Survival ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Risk Score ◽  
Paravalvular Leak ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Sts Score

ObjectiveThe presence of aortic paravalvular leak (PVL) is associated with lower survival, but a direct comparison of its impact after transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) has not been performed. This study sought to determine the differential influence of PVL on survival following TAVR versus SAVR and in patients with varying levels of risk as defined by the Society of Thoracic Surgeons (STS) risk score.MethodsPatients with and without postprocedural PVL were identified from 2290 patients undergoing TAVR or SAVR at Mayo Clinic between 2008 and 2014. The primary endpoint was overall survival.ResultsThere were 588 patients with PVL (374 TAVR, 214 SAVR): age 78±11 years, 63% male and mean follow-up of 3±2 years. PVL was trivial/mild in 442 (75%) patients. In propensity-matched analyses (n=86 per group), the overall survival at 1 and 4 years was 93% and 56% vs 89% and 61% in patients with PVL after TAVR versus SAVR, respectively (p=0.43). The presence or degree of PVL severity had no influence on survival of patients with high STS score (≥8%), while the presence of greater than mild PVL predicted worse survival in those with STS score <8%. During the first year after PVL diagnosis, while either improvement or stable PVL grade was seen in the majority of patients, worsening of PVL grade was more common in the TAVR group (19%) versus the SAVR group (4%) (p<0.0001).ConclusionsAt mid-term follow-up, the presence of PVL was associated with equally unfavourable outcomes following SAVR or TAVR. In patients with high STS risk score, the presence of PVL was not independently associated with increased mortality.

P5986Clinical outcomes of age in patients with severe aortic stenosis treated with Transcatheter Aortic Valve Replacement

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Munoz-Garcia ◽  
M Munoz-Garcia ◽  
A J Munoz Garcia ◽  
F Carrasco-Chinchilla ◽  
A J Dominguez-Franco ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Vascular Complications ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve

Abstract Transcatheter Aortic valve Replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement for patients considered at high or prohibitive operative risk. It is widely known the short and mid-term outcomes, however, is limited about long-term outcomes in according to age. The aim of this study was to determine the survival and the clinical outcomes on based of age. after TAVR with the CoreValve prosthesis. Methods From April 2008 to December 2017, the CoreValve and Sapiens 3 prosthesis were implanted in 667 patients with symptomatic severe aortic stenosis with deemed high risk on base to age, <80 years and ≥80 years old Results The mean age in patients <80 compared with ≥80 years, was 73.6±7 vs. 83.4±2.8 years and the logistic EuroSCORE and STS score were 16.3±11% vs. 18.1±11%. In-hospital mortality was 3.4%, and the combined endpoint of death, vascular complications, myocardial infarction, majopr bleeding or stroke had a rate of 18.3%. The late mortality (beyond 30 days) was 40.5%. When compared both groups, there were no differences for the presence of threatening bleeding 3.5% vs. 3.6% (HR = 1.033 [IC95% 0.452–2.360], p=0.557), myocardial infarction4.2% vs. 2.9% (HR = 0.67 [IC95% 0.290–1,530], p=0.0.226), stroke 8.9% vs. 9.4% (HR = 1.067 [IC95% 0.625–1.821], p=0.814) and mortality 44.5% vs. 41.1% (HR=0.971388 [IC95% 0.639–1.188], p=0.214) and there was difference in between groups in hospitalizations for heart failure 13.8% vs. 7.7% (HR = 1.374 [IC95% 1.037–1.821], p=0.008. Survival at 1, 2, 3, 4, 5 were similar in both groups (86.9% vs. 89.8%, 78.4 vs. 78.3%, 65.5 vs. 72.5%, 57.9% vs. 62.8% and 51.1 vs. 52.8%>; log Rank 0.992, p=0.319), respectively, after a mean follow-up of 43.9±27 months. Conclusions TAVR is associated with significant survival benefit throughout 3.2 years of follow-up. Survival during follow-up was similar in patients with <80 compared with ≥80 years old.

scholarly journals Structural valve deterioration after aortic valve replacement with the Trifecta valve

2020 ◽  
Vol 32 (1) ◽  
pp. 39-46
Author(s):  
Paul Werner ◽  
Jasmin Gritsch ◽  
Sabine Scherzer ◽  
Christoph Gross ◽  
Marco Russo ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Kaplan Meier ◽  
Single Centre Experience ◽  
Structural Valve Deterioration ◽  
Long Term Follow Up ◽  
Valve In Valve

Abstract OBJECTIVES Despite promising short- and mid-term results for durability of the Trifecta valve, contradictory reports of early structural valve deterioration (SVD) do exist. We investigated the incidence of SVD after surgical aortic valve replacement (SAVR) with the Trifecta in our single-centre experience. METHODS Data of 347 consecutive patients (mean age 71.6 ± 9.5 years, 63.4% male) undergoing SAVR with the Trifecta between 2011 and 2017 were analysed. Clinical and echocardiographic reports were obtained with a median follow-up of 41 months (1114 patient years). RESULTS Isolated SAVR was performed in 122 patients (35.2%), whereas 225 patients (64.8%) underwent concomitant procedures. The median EuroSCORE II was 4.0 (0.9; 7.1) and 30-day mortality was 3.7% (n = 13). Kaplan–Meier estimates for the freedom of overall mortality at 1, 5 and 7 years were 88.7 ± 1.7%, 73.7 ± 2.6% and 64.7 ± 4.2%, respectively. SVD was observed in 25 patients (7.2%) with a median time to first diagnosis of 73 months. Freedom of SVD was 92.5 ± 0.9% at 5 years and 65.5 ± 7.1% at 7 years. Thirteen patients underwent reintervention for SVD (6 re-SAVR, 7 valve-in-valve), resulting in a freedom of reintervention for the SVD of 98.5 ± 1.1% at 5 years and 76.9 ± 6.9% at 7 years. CONCLUSIONS We herein report one of the highest rates of SVD after SAVR with the Trifecta. These data indicate that the durability of the prosthesis decreases at intermediate to long-term follow-up, leading to considerable rates of reintervention due to SVD.

scholarly journals The Aortic Annulus Stabilization Technique Prevents Paravalvular Leaks after Rapid Deployment Aortic Valve Implantation

2021 ◽  
Vol 10 (24) ◽  
pp. 5776
Author(s):  
Elena Caporali ◽  
Roberto Lorusso ◽  
Tiziano Torre ◽  
Francesca Toto ◽  
Alberto Pozzoli ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Aortic Valve Implantation ◽  
Stabilization Technique ◽  
Valve Implantation ◽  
Rapid Deployment

Background: Surgical aortic valve replacement with rapid deployment bioprosthesis guarantees good hemodynamic results but carries the risk of paravalvular leaks. To address this issue, an annulus stabilization technique has been recently developed. Methods: Clinical and hemodynamic parameters from patients treated for aortic valve replacement with the rapid deployment bioprosthesis and a concomitant annulus stabilization technique were prospectively collected and retrospectively analyzed. Echocardiographic data at discharge and at 1-year follow-up were collected and analysed. Results: A total of 57 patients (mean age 74.3 ± 6.1 years) with symptomatic aortic valve stenosis underwent aortic valve replacement with the rapid deployment bioprosthesis and concomitant annulus stabilization technique (mean valve size: 23.8 ± 1.9 mm). Combined procedures accounted for 56.1%. Hospital mortality was 1.8% and a new pacemaker for conduction abnormalities was implanted in 10 patients. The pre-discharge echocardiographic control showed absence of paravalvular leaks of any degree in all patients with mean valve gradient of 9.6 ± 4.0 mmHg. The 1-year echocardiographic control confirmed the good valve hemodynamic (mean gradient of 8.0 ± 2.8 mmHg) and absence of leaks. Conclusion: In this preliminary clinical experience, the annulus stabilization technique prevents postoperative paravalvular leaks after rapid deployment aortic valve implantation, up to 1-year postoperatively. Studies on larger series are of paramount importance to confirm the long-term efficacy of this new surgical technique.

scholarly journals Anticoagulation and outcomes after surgical aortic valve replacement with a biological prosthesis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Angleitner ◽  
M Zinggl ◽  
P Werner ◽  
I Coti ◽  
M Mach ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Term Survival ◽  
Logistic Euroscore ◽  
Biological Prosthesis ◽  
Kaplan Meier

Abstract Background No strong recommendation exists regarding the use of short-term anticoagulation after surgical aortic valve replacement (SAVR) with a biological prosthesis. Purpose Our aim was to analyze outcomes of patients receiving warfarin versus low-molecular weight heparin (LMWH) after isolated SAVR. Methods We retrospectively analyzed all adult patients who underwent surgery between 2009 and 2017 at our department (n=598). Exclusion criteria included pre-operative anticoagulation, atrial fibrillation, dialysis, previous aortic valve replacement, or active endocarditis. Patients who were discharged alive were stratified according to the type of anticoagulation (warfarin, n=332, 55.5%; LMWH, n=266, 44.5%). Long-term survival during the follow-up period was analyzed (median follow-up, 5.6 years). Results Patients who received warfarin had significantly lower logistic EuroSCORE and were younger (Table 1). Warfarin was more frequently utilized between 2009 and 2014, whereas LMWH was more commonly used between 2015 and 2017. Kaplan-Meier curves in Figure 1 show that patients who received warfarin had significantly superior long-term survival (log-rank test: p=0.002). Multivariable Cox proportional hazards regression analysis confirmed that the use of warfarin was associated with significantly lower risk of long-term mortality when compared with LMWH (hazard ratio [HR] 0.50, 95% confidence interval [CI] 0.34–0.74, p=0.001). Covariables in this model included logistic EuroSCORE, era, and duration of cardiopulmonary bypass. Conclusions The present analysis suggests that the use of warfarin is associated with significantly superior survival after SAVR with a biological prosthesis. Our findings require validation in a prospective randomized controlled trial. Figure 1. Kaplan-Meier survival curves Funding Acknowledgement Type of funding source: None

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