Download PDF
Thorac Cardiovasc Surg 2023; 71(05): 366-375
DOI: 10.1055/s-0042-1742364
Original Cardiovascular

Results of Four-Stented Biological Aortic Valves and How They Compare to PARTNER-3

Jacqueline Rashvand
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School “Theodor Fontane,” Bernau, Brandenburg, Germany
,
Roya Ostovar
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School “Theodor Fontane,” Bernau, Brandenburg, Germany
,
Filip Schroeter
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School “Theodor Fontane,” Bernau, Brandenburg, Germany
,
Martin Hartrumpf
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School “Theodor Fontane,” Bernau, Brandenburg, Germany
,
Ralf-Uwe Kuehnel
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School “Theodor Fontane,” Bernau, Brandenburg, Germany
,
Johannes M. Albes
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School “Theodor Fontane,” Bernau, Brandenburg, Germany
› Author Affiliations
› Further Information
    Permissions and Reprints All articles of this category

Abstract

Objective According to our nationwide registry, total numbers of surgical aortic valve implantation (sAVR) are constantly declining, while transcathether aortic valve implantation (TAVI) indications are widened toward intermediate- and low-risk patients. So, is there still room for conventionally implanted valves? Can results compete with TAVI or will sAVR be marginalized in the near future?

Methods Between 2011 and 2019, 1,034 patients (67.1% male, mean = 72.2 years) were enrolled receiving stented biological valves with or without concomitant coronary artery bypass grafting (CABG), atrial ablation, or wrapping of the ascending aorta. Odds ratios for the early and late mortality were calculated regarding comorbidities as potential risk factors. Statistical analysis was performed using SPSS.

Results Overall, early mortality (EM) was 6.1%, 1-year mortality was 11.2%, and 5-year mortality was 19.9%. In low-risk patients (EuroSCORE II <4%), it was 1.0, 2.7, and 9.3%. Incidence of EM was significantly increased following decompensation, prosthetic valve, pacemaker carrier, dialysis, and pulmonary hypertension. Postoperative complications, such as systemic inflammatory response syndrome (SIRS), sepsis, multiorgan failure, hepatic failure, dialysis, gastrointestinal bleeding, and ileus, also increased EM. Late mortality was significantly increased by dialysis, hepatic cirrhosis, infected port system, aortic valve endocarditis, prosthetic valve carrier, and chronic hemodialysis.

Conclusion Conventionally implanted aortic valves do well early and late. The fate of the patient is dependent on individual risk-factors. Particularly, in low-risk patients, sAVR can compete with TAVI showing overall good early, as well as late results being even superior in some important aspects such as pacemaker implantation rate. Thus, the time is yet not ripe for TAVI to take over primary indications for AVR in low-risk patient.

Keywords

aortic valve and root - outcomes - heart valve surgery

Note

This study was presented at the 50th Annual Meeting of the German Society of Thoracic, Cardiac, and Vascular Surgery, February 26–28, 2021.




Publication History

Received: 13 September 2021

Accepted: 23 November 2021

Article published online:
10 February 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Beckmann A, Meyer R, Lewandowski J, Markewitz A, Gummert J. German Heart Surgery Report 2020: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2021; 69 (04) 294-307
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Muller Moran HR, Eikelboom R, Lodewyks C. et al. Two-year outcomes from the PARTNER 3 trial: where do we stand?. Curr Opin Cardiol 2021; 36 (02) 141-147
    CrossrefPubMedSearch in Google Scholar
  • 3 Braghiroli J, Kapoor K, Thielhelm TP, Ferreira T, Cohen MG. Transcatheter aortic valve replacement in low risk patients: a review of PARTNER 3 and Evolut low risk trials. Cardiovasc Diagn Ther 2020; 10 (01) 59-71
    CrossrefPubMedSearch in Google Scholar
  • 4 Popma JJ, Deeb GM, Yakubov SJ. et al; Evolut Low Risk Trial Investigators. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med 2019; 380 (18) 1706-1715
    CrossrefPubMedSearch in Google Scholar
  • 5 Mack MJ, Leon MB, Thourani VH. et al; PARTNER 3 Investigators. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 2019; 380 (18) 1695-1705
    CrossrefPubMedSearch in Google Scholar
  • 6 Khalil KN, Forcillo J. SAVR contemporary outcomes in TAVI era: still a valid option for the future. J Card Surg 2021; 36 (04) 1477-1478
    CrossrefPubMedSearch in Google Scholar
  • 7 R Core Team. The R project for statistical computing. Accessed December 17, 2021: https://www.R-project.org/
    PubMed
  • 8 Haldane JBS. The estimation and significance of the logarithm of a ratio of frequencies. Ann Hum Genet 1956; 20 (04) 309-311
    CrossrefPubMedSearch in Google Scholar
  • 9 Anscombe FJ. On estimating binomial response relations. Biometrika 1956; 43 (03) 461-464
    CrossrefPubMedSearch in Google Scholar
  • 10 Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Association 1958; 53 (282) 457-481
    CrossrefPubMedSearch in Google Scholar
  • 11 Bone RC, Balk RA, Cerra FB. et al; The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992; 101 (06) 1644-1655
    CrossrefPubMedSearch in Google Scholar
  • 12 Brunkhorst FM, Weigand MA, Pletz M. et al. S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : long version [in German]. Med Klin Intensivmed Notfmed 2020; 115 (Suppl. 02) 37-109
    CrossrefPubMedSearch in Google Scholar
  • 13 Kuck K, Bleiziffer S, Eggebrecht H. et al. Konsensuspapier der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Thorax-, Herz- und Gefäßchirurgie (DGTHG) zur kathetergestützten Aortenklappenimplantation (TAVI) 2020. Kardiologe 2020; 14: 182-204
    CrossrefPubMedSearch in Google Scholar
  • 14 Patel KV, Omar W, Gonzalez PE. et al. Expansion of TAVR into low-risk patients and who to consider for SAVR. Cardiol Ther 2020; 9 (02) 377-394
    CrossrefPubMedSearch in Google Scholar
  • 15 Tamburino C, Valvo R, Crioscione E. et al. The path of transcatheter aortic valve implantation: from compassionate to low-risk cases. Eur Heart J Suppl 2020; 22 (suppl L): L140-L145
    CrossrefPubMedSearch in Google Scholar
  • 16 Luthra S, Ohri SK. Transcatheter aortic valve implantation is still inappropriate in low-risk, young patients: a UK perspective. Br J Hosp Med (Lond) 2021; 82 (03) 1-4
    Search in Google Scholar
  • 17 Hartrumpf M, Kuehnel RU, Schroeter F. et al. Clinical short-term outcome and hemodynamic comparison of six contemporary bovine aortic valve prostheses. Thorac Cardiovasc Surg 2020; 68 (07) 557-566
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Nashef SA, Sharples LD, Roques F, Lockowandt U. EuroSCORE II and the art and science of risk modelling. Eur J Cardiothorac Surg 2013; 43 (04) 695-696
    CrossrefPubMedSearch in Google Scholar
  • 19 Albes JM. Current practice in prophylaxis of endocarditis: are we running into trouble?. Eur J Cardiothorac Surg 2019; 56 (01) 1-6
    CrossrefPubMedSearch in Google Scholar
  • 20 Habib G, Lancellotti P, Antunes MJ. et al; ESC Scientific Document Group. 2015 ESC guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36 (44) 3075-3128
    CrossrefPubMedSearch in Google Scholar
  • 21 Harding D, Cahill TJ, Redwood SR, Prendergast BD. Infective endocarditis complicating transcatheter aortic valve implantation. Heart 2020; 106 (07) 493-498
    CrossrefPubMedSearch in Google Scholar
  • 22 Forrest JK, Ramlawi B, Deeb GM. et al. Transcatheter aortic valve replacement in low-risk patients with bicuspid aortic valve stenosis. JAMA Cardiol 2021; 6 (01) 50-57
    PubMedSearch in Google Scholar
  • 23 Ostovar R, Schroeter F, Kuehnel RU. et al. Endocarditis: an ever increasing problem in cardiac surgery. Thorac Cardiovasc Surg 2019; 67 (08) 616-623
    Thieme ConnectPubMedSearch in Google Scholar
  • 24 Ki YJ, Kang J, Lee HS. et al. Optimal oversizing index depending on valve type and leakage-proof function for preventing paravalvular leakage after transcatheter aortic valve implantation. J Clin Med 2020; 9 (12) 3936
    CrossrefPubMedSearch in Google Scholar
  • 25 van Wely M, van der Wulp K, Rooijakkers M. et al. Aortic regurgitation index ratio is a strong predictor of 1-year mortality after transcatheter aortic valve implantation using self-expanding devices. Semin Thorac Cardiovasc Surg 2021; 33 (04) 923-930
    CrossrefPubMedSearch in Google Scholar
  • 26 Ko TY, Lin MS, Lin LC. et al. Frequency and significance of intravascular hemolysis before and after transcatheter aortic valve implantation in patients with severe aortic stenosis. Am J Cardiol 2018; 121 (01) 69-72
    CrossrefPubMedSearch in Google Scholar
  • 27 Giordana F, Bruno F, Conrotto F. et al. Incidence, predictors and outcomes of valve-in-valve TAVI: a systematic review and meta-analysis. Int J Cardiol 2020; 316: 64-69
    CrossrefPubMedSearch in Google Scholar