Contemporary Results for Isolated Aortic Valve Surgery

Abstract

Background: We aimed to give an overview of the contemporary status of aortic valve replacement. Materials and Methods: This single-center prospective study was initiated in January 2003. From this date on, every patient with aortic valve disease admitted to our hospital was reviewed by a cardiologist and a surgeon to determine eligibility for replacement. In no instance was the operation denied in the absence of surgical consultation. All operations were performed using a median sternotomy, with cardiopulmonary bypass and cardioplegic arrest. Results: A total of 873 cases were screened until the end of the study. We identified three groups of patients: Group 1 (inoperable cases) consisted of 15 patients (1 %); Group 2 (high-risk cases) included 99 patients with an additive EuroSCORE ≥ 10 or an expected mortality > 20 % (logistic model); Group 3 (moderate- to low-risk cases) consisted of 759 patients with an additive EuroSCORE < 10 or an expected mortality < 20 %. In-hospital mortality was 6.0 % (6/99) for Group 2 and 0.3 % (3/759) for Group 3. Major complications occurred in 5 patients of Group 2 (5 %) and in 9 patients of Group 3 (1.1 %). At predischarge echocardiography, 99.3 % of the implanted valves were perfect. At a follow-up of 28.9 ± 12.3 months 798/849 patients were alive; 89 % of them (711) were in NYHA 1–2. Conclusions: Surgical aortic valve replacement provides excellent results and has a low operative mortality even in high-risk patients. Surgical consultation for every aortic patient resulted in an extremely low rate of surgery refusals. Our data should be regarded as a benchmark for transcatheter techniques.

Key words

aortic valve & root - surgery - complications - outcomes (includes mortality - morbidity)

References

• 1 Barnhorst D A, Oxman H A, Connolly D C et al. Isolated replacement of the aortic valve with the Starr-Edwards prosthesis. A 9 year review.  J Thorac Cardiovasc Surg. 1975;  70 113-118
• 2 Cribier A, Eltchaninoff H, Tron C et al. Percutaneous implantation of aortic valve prosthesis in patients with calcific aortic stenosis: technical advances, clinical results and future strategies.  J Interven Cardiol. 2006;  19 S87-S96
• 3 Cribier A, Eltchaninoff H, Tron C et al. Treatment of calcific aortic stenosis with percutaneous heart valve – mid-term follow-up from the initial feasibility studies: the French experience.  J Am Coll Cardiol. 2006;  47 1214-1223
• 4 Webb J, Chandavimol M, Thompson C et al. Percutaneous aortic valve implantation retrograde from the femoral artery.  Circulation. 2006;  113 842-850
• 5 Lung B, Baron G, Butchart E G et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease.  Eur Heart J. 2003;  24 1231-1243
• 6 Vahanian A, Alfieri O R, Al-Attar N et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-thoracic Surgery and the European Society of Cardiology, in collaboration with the European Society of Percutaneous Cardiovascular Interventions.  Eur J Cardio-Thorac Surgery. 2008;  34 1-8
• 7 Robicseck F. Will the use of percutaneous valve remain compassionate?.  Eur J Cardio-Thorac Surgery. 2008;  34 9-10
• 8 Edmunds L H, Clark R E, Cohn L H et al. Guidelines for reporting morbidity and mortality after cardiac valvular operations.  J Thorac Cardiovasc Surg. 1996;  112 708-711
• 9 Roques F, Nashef S A, Michel P et al. Risk factors and outcome of in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients.  Eur J Cardio-Thorac Surg. 1999;  15 816-822
• 10 Possati G, Gaudino M. Finding a compromise between the heart and the brain: strategies for stroke risk reduction in coronary artery surgery.  Ital Heart J. 2002;  3 146-150
• 11 Carabello B A. Clinical practice. Aortic stenosis.  New Engl J Med. 2002;  349 677-682
• 12 Yan T D, Cao C, Martens-Nielsen J et al. Transcatheter aortic valve implantation for high-risk patients with severe aortic stenosis: a systematic review.  J Thorac Cardiovasc Surg. 2010;  139 1519-1528
• 13 Osswald B R, Gegouskov V, Badowski-Zyla D et al. Overestimation of aortic valve replacement risk by EuroSCORE: implications for percutaneous valve replacement.  Eur Heart J. 2009;  30 74-80