Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database.
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Jahangiri Marjan, Bilkhu Rajdeep, Embleton-Thirsk Andrew, Dehbi Hakim-Moulay, Mani Krishna, Anderson Jon, Avlonitis Vassilios, Baghai Max, Birdi Inderpaul, Booth Karen, Bose Amal, Briffa Norman, Buchan Keith, Bhudia Sunil, Cale Alex, Deglurkar Indu, Farid Shakil, Hadjinikolaou Leonidas, Jarvis Martin, Javadpour Seyed Hossein, Jeganathan Reubendra, Kuduvalli Manoj, Lall Kulvinder, Mascaro Jorge, Mehta Dheeraj, Ohri Sunil, Punjabi Prakash, Venkateswaran Rajamiyer, Ridley Paul, Satur Christopher, Stoica Serban, Trivedi Uday, Zaidi Afzal, Yiu Patrick, Moorjani Narain, Kendall Simon, Freemantle Nick
Аннотация
DESIGN: Retrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants' demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed.
SETTING: 27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis.
PARTICIPANTS: 31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG.
RESULTS: In-hospital mortality for isolated SAVR was 1.9% (95% CI 1.6% to 2.1%) and was 2.4% for AVR+CABG. Mortality by age category for SAVR only were: <60 years=2.0%, 60-75 years=1.5%, >75 years=2.2%. For SAVR+CABG these were; 2.2%, 1.8% and 3.1%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3%, in intermediate risk 1% and for high risk 3.9%. 74.3% of the operations were elective, 24% urgent and 1.7% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9% and 1.1%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes.
CONCLUSIONS: Surgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease.