Surgical Aortic Valve Replacement—Age-Dependent Choice of Prosthesis Type

Background: Recently, the use of surgically implanted aortic bioprostheses has been favoured in younger patients. We aimed to analyse the long-term survival and postoperative MACCE (Major Adverse Cardiovascular and Cerebral Event) rates in patients after isolated aortic valve replacement. Methods: We conducted a single-centre observational retrospective study, including all consecutive patients with isolated aortic valve replacement. 1:1 propensity score matching of the preoperative baseline characteristics was performed. Results: A total of 2172 patients were enrolled in the study. After propensity score matching the study included 428 patients: 214 biological vs. 214 mechanical prostheses, divided into two subgroups: group A < 60 years and group B > 60 years. The mean follow-up time was 7.6 ± 3.9 years. Estimated survival was 97 ± 1.9% and 89 ± 3.4% at 10 years for biological and mechanical prosthesis, respectively in group A (p = 0.06). In group B the survival at 10 years was 79.1 ± 5.8% and 69.8 ± 4.4% for biological and mechanical prosthesis, respectively (p = 0.83). In group A, patients with a bioprosthesis exhibited a tendency for higher cumulative incidence MACCE rates compared to patients with a mechanical prosthesis, p = 0.83 (bio 7.3 ± 5.3% vs. mech 4.6 ± 2.2% at 10 years). In group B, patients with a mechanical prosthesis showed a tendency for higher cumulative incidence MACCE rates compared to patients with bioprosthesis, p = 0.86 (bio 4.3 ± 3.1% vs. mech 9.1 ± 3.1% at 10 years). Conclusions: Long-term survival after surgical aortic valve replacement is similar in patients with a biological and mechanical prosthesis, independent of the patients’ age. Moreover, younger patients (<60 years) with bioprosthesis showed a survival benefit, compared to patients with mechanical prosthesis in this age group.

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Determining Which Prosthetic to Use During Aortic Valve Replacement in Patients Aged Younger than 70 Years: A Systematic Review of the Literature

The Heart Surgery Forum ◽

10.1532/hsf.2131 ◽

1969 ◽

Vol 22 (2) ◽

pp. E070-E081 ◽

Cited By ~ 1

Author(s):

Philip Borger ◽

Eric J Charles ◽

Eric D Smith ◽

J Hunter Mehaffey ◽

Robert B Hawkins ◽

...

Keyword(s):

Systematic Review ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Mechanical Prosthesis ◽

Term Survival ◽

Younger Patients ◽

Long Term Survival ◽

Mechanical Prostheses

Background: The choice of bioprosthesis versus mechanical prosthesis in patients aged less than 70 years undergoing aortic valve replacement (AVR) remains controversial, with guidelines disparate in their recommendations. The objective of this study was to explore outcomes after AVR for various age ranges based on type of prosthesis. Methods: A systematic review was undertaken according to the Preferred Reporting Instructions for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by using Medline (PubMed), Cochrane, Web of Science, Embase, and Scopus databases. Rates of long-term survival (primary outcome), reoperation, major bleeding, thromboembolism, stroke, structural valve deterioration, and endocarditis were compared between subjects receiving biologic and mechanical prostheses. Findings were grouped into patients aged <60 years, aged ≤65 years, and finally aged <70 years. Results: A total of 19 studies met inclusion criteria. Seven evaluated patients aged <60 years, 4 of which found mechanical prosthesis patients to have higher long-term survival, whereas the remaining studies found no difference. Eight additional studies included patients aged 65 years or younger, and 9 studies included patients aged <70 years. The former found no difference in survival between prosthesis groups, whereas the latter favored mechanical prostheses in 3 studies. Bleeding, thromboembolism, and stroke were more prevalent in patients with a mechanical prosthesis, whereas reoperation was more common in those receiving a bioprosthesis. Conclusions: Published literature does not preclude the use of bioprostheses for AVR in younger patients. As new valves are developed, the use of bioprosthetic aortic valves in younger patients will likely continue to expand. Clinical trials are needed to provide surgeons with more accurate guidelines.

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Long-term survival after surgical aortic valve replacement among patients over 65 years of age

Open Heart ◽

10.1136/openhrt-2015-000338 ◽

2016 ◽

Vol 3 (1) ◽

pp. e000338 ◽

Cited By ~ 21

Author(s):

Mansour T A Sharabiani ◽

Francesca Fiorentino ◽

Gianni D Angelini ◽

Nishith N Patel

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Surgical Aortic Valve Replacement ◽

Term Survival ◽

Long Term Survival

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DIABETES MELLITUS DOES NOT WORSEN LONG-TERM SURVIVAL FOLLOWING ISOLATED SURGICAL AORTIC VALVE REPLACEMENT: A PROPENSITY MATCHED ANALYSIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(16)32200-8 ◽

2016 ◽

Vol 67 (13) ◽

pp. 2199

Author(s):

Benjamin van Boxtel ◽

Robert Sorabella ◽

Nathaniel Langer ◽

Nathaniel Kheysin ◽

Andres Gomez ◽

...

Keyword(s):

Diabetes Mellitus ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Surgical Aortic Valve Replacement ◽

Term Survival ◽

Long Term Survival

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Preoperative Atrial Fibrillation is associated with long-term morTality in patients undergoing suRgical AortiC valvE Replacement

10.22541/au.162177926.67920109/v1 ◽

2021 ◽

Author(s):

Mohamed Farag ◽

Yusuf Kiberu ◽

Ashwin Reddy ◽

Ahmad Shoaib ◽

Mohaned Egred ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Surgical Aortic Valve Replacement ◽

Term Survival ◽

The Impact ◽

Long Term Mortality

Introduction Atrial fibrillation (AF) is frequent after any cardiac surgery, but evidence suggests it may have no significant impact on survival if sinus rhythm (SR) is effectively restored early after the onset of the arrhythmia. In contrast, management of preoperative AF is often overlooked during or after cardiac surgery despite several proposed protocols. This study sought to evaluate the impact of preoperative AF on mortality in patients undergoing isolated surgical aortic valve replacement (AVR). Methods We performed a retrospective, single-centre study involving 2,628 consecutive patients undergoing elective, primary isolated surgical AVR from 2008 to 2018. A total of 268/ 2,628 patients (10.1%) exhibited AF before surgery. The effect of preoperative AF on mortality was evaluated with univariate and multivariate analyses. Results Short-term mortality was 0.8% and was not different between preoperative AF and SR cohorts. Preoperative AF was highly predictive of long-term mortality (median follow-up of 4 years [Q1-Q3 2-7]; HR: 2.24, 95% CI: 1.79-2.79, P<0.001), and remained strongly and independently predictive after adjustment for other risk factors (HR: 1.54, 95% CI: 1.21-1.96, P<0.001) compared with preoperative SR. In propensity score-matched analysis, the adjusted mortality risk was higher in the AF cohort (OR: 1.47, 95% CI: 1.04-1.99, P=0.03) compared with the SR cohort. Conclusions Preoperative AF was independently predictive of long-term mortality in patients undergoing isolated surgical AVR. It remains to be seen whether concomitant surgery or other preoperative measures to correct AF may impact long-term survival.

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Re-sternotomy for aortic valve replacement in octogenarian patients Submission category -- Original article

10.22541/au.163734449.99865558/v1 ◽

2021 ◽

Author(s):

Suvitesh Luthra ◽

Pietro Giorgio Malvindi ◽

Hannah Masraf ◽

Anna Podonyi ◽

Taha Ramadan ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Inpatient Mortality ◽

Surgical Aortic Valve Replacement ◽

Term Survival ◽

Long Term Survival ◽

Survival Difference ◽

And Gender

Background The aim of this study was to analyse the perioperative results and long term survival of re-sternotomy for surgical aortic valve replacement (SAVR) in octogenarians. Methods This is a retrospective, single centre study (Apr 2000 – Dec 2019). Perioperative data were compared for re-sternotomy with isolated SAVR (Isolated redoSAVR) and re-sternotomy with SAVR and concomitant cardiac procedure (Associated redoSAVR). Regression analyses were performed to identify predictors of in patient mortality. Hazard ratios were calculated, and Kaplan Meier survival curves were compared for groups. Results There were 163 patients (Isolated redoSAVR; 69, Associated redoSAVR; 94). Mean age was 83±3 years and mean logEuroSCORE was 21±12. Follow up was 4.2±3.5 years. Inpatient mortality was 4.9% (1.4% versus 7.4% for Isolated redoSAVR and Associated redoSAVR respectively, p=0.08). TIA/stroke rate was 8% (9% versus 7% for Isolated redoSAVR and Associated redoSAVR respectively, p=0.78). COPD was a predictor of inpatient mortality (OR; 8.86, 95%CI; 1.19, 66.11, p=0.03). Survival was 88.7% at 1 year, 86.4% at 2 years, 70.1% at 5 years, 49.5% at 7 years and 26.3% at 10 years. There was no survival difference between Isolated redoSAVR and Associated redoSAVR (logrank p=0.36, Wilcoxon p=0.84). Significant predictors of adverse long term survival were COPD, postoperative TIA/stroke and length of stay. Survival is lower than age and gender matched first time SAVR and general population of UK. Conclusions RedoSAVR in octogenarians is associated with acceptable but significant morbidity and mortality. Shared decision making should consider emerging transcatheter therapies as viable options in selected patients.

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

European Heart Journal ◽

10.1093/ehjci/ehaa946.2689 ◽

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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Predictive factors of long-term survival in the octogenarian undergoing surgical aortic valve replacement: 12-year single-centre follow-up

Heart and Vessels ◽

10.1007/s00380-016-0804-3 ◽

2016 ◽

Vol 31 (11) ◽

pp. 1798-1805 ◽

Cited By ~ 11

Author(s):

Giangiuseppe Cappabianca ◽

Sandro Ferrarese ◽

Andrea Musazzi ◽

Francesco Terrieri ◽

Claudio Corazzari ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Predictive Factors ◽

Single Centre ◽

Surgical Aortic Valve Replacement ◽

Term Survival ◽

Long Term Survival

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Benefits and Pitfalls of the Perceval Sutureless Bioprosthesis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.789392 ◽

2022 ◽

Vol 8 ◽

Author(s):

Aleksander Dokollari ◽

Basel Ramlawi ◽

Gianluca Torregrossa ◽

Michel Pompeu Sá ◽

Serge Sicouri ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Clinical Studies ◽

Pacemaker Implantation ◽

Hospital Length Of Stay ◽

Paravalvular Leak ◽

Surgical Aortic Valve Replacement ◽

Term Survival

Objective: To highlight the main target points covered by clinical studies on the Perceval sutureless valve for surgical aortic valve replacement (SAVR) and raise a point of discussion for further expansion of its use when compared with stented bioprostheses (SB) and transcatheter aortic valve replacement (TAVR).Methods: We reviewed clinical trials and retrospective studies published up to date and compared the outcomes in terms of mortality, myocardial infarction (MI) stroke, paravalvular leak (PVL), permanent pacemaker implantation (PPI), bleeding and long-term outcomes.Results: Clinical studies showed that 30-day mortality ranged from 0–4% for Perceval and 2.9–7% for TAVR. The incidence of PVL (Perceval 1.9–19.4 vs. TAVR 9–53.5%), PPI (Perceval 2–11.2 vs. TAVR 4.9–25.5%), stroke (Perceval 0 vs. TAVR 0–2.8%), MI (Perceval 0 vs. TAVR 0–3.5%), were all higher in the TAVR group. Compared to other SB, mortality ranged from 0–6.4% for Perceval and 0–5.9% for SB. The incidence of PVR (Perceval 1–19.4 vs. SB 0–1%), PPI (Perceval 2–10.7 vs. SB 1.8–8.5%), stroke (Perceval 0–3.7 vs. SB 1.8–7.3%) and MI (Perceval 0–7.8 vs. SB 0–4.3%) were comparable among the groups. In patients with a bicuspid aortic valve, mortality rate was (0–4%) and PVL incidence was (0–2.3%). However, there was a high incidence of PPI (0–20%), and stroke (0–8%). Long-term survival ranged between 96.7–98.6%.Conclusions: The Perceval bioprosthesis has proved to be a reliable prosthesis for surgical aortic valve replacement due to its implantation speed, the reduced cardiopulmonary bypass time, the reduced aortic cross-clamp time and the shorter intensive care unit and hospital length of stay.

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Transcatheter versus Isolated Surgical Aortic Valve Replacement in Young High-Risk Patients: A Propensity Score-Matched Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10153447 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3447

Author(s):

Markus Mach ◽

Thomas Poschner ◽

Waseem Hasan ◽

Tillmann Kerbel ◽

Philipp Szalkiewicz ◽

...

Keyword(s):

Survival Rate ◽

High Risk ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Surgical Aortic Valve Replacement ◽

Term Survival ◽

High Risk Patients ◽

Risk Patients

Background: Younger patients with severe symptomatic aortic stenosis are a particularly challenging collective with regard to the choice of intervention. High-risk patients younger than 75 years of age are often eligible for both the transcatheter aortic valve replacement (TAVR) and the isolated surgical aortic valve replacement (iSAVR). Data on the outcomes of both interventions in this set of patients are scarce. Methods: One hundred and forty-four propensity score-matched patients aged 75 years or less who underwent TAVR or iSAVR at the Hietzing Heart Center in Vienna, Austria, were included in the study. The mean age was 68.9 years (TAVR 68.7 vs. SAVR 67.6 years; p = 0.190) and the average EuroSCORE II was 5.4% (TAVR 4.3 [3.2%] vs. iSAVR 6.4 (4.3%); p = 0.194). Results: Postprocedural adverse event data showed higher rates of newly acquired atrial fibrillation (6.9% vs. 19.4%; p = 0.049), prolonged ventilation (2.8% vs. 25.0%; p < 0.001) and multi-organ failure (0% vs. 6.9%) in the surgical cohort. The in-hospital and 30-day mortality was significantly higher for iSAVR (1.4% vs. 13.9%; p = 0.012; 12.5% vs. 2.8%; p = 0.009, respectively). The long-term survival (median follow-up 5.0 years (2.2–14.1 years)) of patients treated with the surgical approach was superior to that of patients undergoing TAVR (p < 0.001). Conclusion: Although the survival analysis revealed a higher in-hospital and 30-day survival rate for high-risk patients aged ≤75 years who underwent TAVR, iSAVR was associated with a significantly higher long-term survival rate.

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