Outcomes of surgical aortic valve replacement in moderate risk patients: Implications for determination of equipoise in the transcatheter era

Sebastian A. Iturra, Rakesh M. Suri, Kevin L. Greason, John M. Stulak, Harold M. Burkhart, Joseph A. Dearani, Hartzell V Schaff

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: To determine the contemporary outcomes of surgical aortic valve replacement (SAVR) in a moderate surgical risk population. Methods: We studied 502 consecutive adults who had undergone isolated SAVR from January 2002 to June 2011 for severe aortic valve stenosis with a Society of Thoracic Surgery predicted risk of mortality of 4% to 8%. We included concomitant coronary artery bypass and aortic annular enlargement but not other concomitant procedures. The updated Valve Academic Research Consortium definitions were used, as appropriate. Results: The median age was 80 years (range, 49-96), 323 (64.3%) had New York Heart Association class III-IV symptoms, and 101 (20.1%) had undergone previous coronary artery bypass grafting. The mean predicted risk of mortality was 5.6%. Concomitant coronary artery bypass grafting was performed in 270 (53.8%). Re-exploration for bleeding occurred in 29 (5.8%), stroke in 9 (1.8%), and vascular complications in 2 (0.4%). In the cohort, 14 early deaths (2.8%) occurred. During follow-up (1174 days), 175 patients died. Using multivariate logistic regression analysis, the significant independent predictors of mid-term death included chronic pulmonary disease (hazard ratio, 2.00, 95% confidence interval, 1.41-2.84; P <.001), peripheral vascular disease (hazard ratio, 1.58; 95% confidence interval, 1.05-2.37; P =.029), and atrial fibrillation (hazard ratio, 1.75; 95% confidence interval, 1.16-2.65; P =.008). Conclusions: SAVR in moderate-risk patients is currently performed with one half of the early predicted risk (2.8%) and a low likelihood of complications, including a 1.8% incidence of stroke. Patients counseled for randomization to transcatheter aortic valve insertion should be informed of the excellent early to mid-term outcomes of SAVR, particularly those without pulmonary impairment, peripheral vascular disease, or atrial fibrillation.

Original languageEnglish (US)
Pages (from-to)127-132
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume147
Issue number1
DOIs
StatePublished - Jan 2014

Fingerprint

Aortic Valve
Surgical Instruments
Coronary Artery Bypass
Peripheral Vascular Diseases
Confidence Intervals
Atrial Fibrillation
Stroke
Mortality
Aortic Valve Stenosis
Random Allocation
Lung Diseases
Thoracic Surgery
Blood Vessels
Chronic Disease
Logistic Models
Regression Analysis
boldenone undecylenate
Hemorrhage
Lung
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Outcomes of surgical aortic valve replacement in moderate risk patients : Implications for determination of equipoise in the transcatheter era. / Iturra, Sebastian A.; Suri, Rakesh M.; Greason, Kevin L.; Stulak, John M.; Burkhart, Harold M.; Dearani, Joseph A.; Schaff, Hartzell V.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 147, No. 1, 01.2014, p. 127-132.

Research output: Contribution to journalArticle

Iturra, Sebastian A. ; Suri, Rakesh M. ; Greason, Kevin L. ; Stulak, John M. ; Burkhart, Harold M. ; Dearani, Joseph A. ; Schaff, Hartzell V. / Outcomes of surgical aortic valve replacement in moderate risk patients : Implications for determination of equipoise in the transcatheter era. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 147, No. 1. pp. 127-132.
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abstract = "Objective: To determine the contemporary outcomes of surgical aortic valve replacement (SAVR) in a moderate surgical risk population. Methods: We studied 502 consecutive adults who had undergone isolated SAVR from January 2002 to June 2011 for severe aortic valve stenosis with a Society of Thoracic Surgery predicted risk of mortality of 4{\%} to 8{\%}. We included concomitant coronary artery bypass and aortic annular enlargement but not other concomitant procedures. The updated Valve Academic Research Consortium definitions were used, as appropriate. Results: The median age was 80 years (range, 49-96), 323 (64.3{\%}) had New York Heart Association class III-IV symptoms, and 101 (20.1{\%}) had undergone previous coronary artery bypass grafting. The mean predicted risk of mortality was 5.6{\%}. Concomitant coronary artery bypass grafting was performed in 270 (53.8{\%}). Re-exploration for bleeding occurred in 29 (5.8{\%}), stroke in 9 (1.8{\%}), and vascular complications in 2 (0.4{\%}). In the cohort, 14 early deaths (2.8{\%}) occurred. During follow-up (1174 days), 175 patients died. Using multivariate logistic regression analysis, the significant independent predictors of mid-term death included chronic pulmonary disease (hazard ratio, 2.00, 95{\%} confidence interval, 1.41-2.84; P <.001), peripheral vascular disease (hazard ratio, 1.58; 95{\%} confidence interval, 1.05-2.37; P =.029), and atrial fibrillation (hazard ratio, 1.75; 95{\%} confidence interval, 1.16-2.65; P =.008). Conclusions: SAVR in moderate-risk patients is currently performed with one half of the early predicted risk (2.8{\%}) and a low likelihood of complications, including a 1.8{\%} incidence of stroke. Patients counseled for randomization to transcatheter aortic valve insertion should be informed of the excellent early to mid-term outcomes of SAVR, particularly those without pulmonary impairment, peripheral vascular disease, or atrial fibrillation.",
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T1 - Outcomes of surgical aortic valve replacement in moderate risk patients

T2 - Implications for determination of equipoise in the transcatheter era

AU - Iturra, Sebastian A.

AU - Suri, Rakesh M.

AU - Greason, Kevin L.

AU - Stulak, John M.

AU - Burkhart, Harold M.

AU - Dearani, Joseph A.

AU - Schaff, Hartzell V

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N2 - Objective: To determine the contemporary outcomes of surgical aortic valve replacement (SAVR) in a moderate surgical risk population. Methods: We studied 502 consecutive adults who had undergone isolated SAVR from January 2002 to June 2011 for severe aortic valve stenosis with a Society of Thoracic Surgery predicted risk of mortality of 4% to 8%. We included concomitant coronary artery bypass and aortic annular enlargement but not other concomitant procedures. The updated Valve Academic Research Consortium definitions were used, as appropriate. Results: The median age was 80 years (range, 49-96), 323 (64.3%) had New York Heart Association class III-IV symptoms, and 101 (20.1%) had undergone previous coronary artery bypass grafting. The mean predicted risk of mortality was 5.6%. Concomitant coronary artery bypass grafting was performed in 270 (53.8%). Re-exploration for bleeding occurred in 29 (5.8%), stroke in 9 (1.8%), and vascular complications in 2 (0.4%). In the cohort, 14 early deaths (2.8%) occurred. During follow-up (1174 days), 175 patients died. Using multivariate logistic regression analysis, the significant independent predictors of mid-term death included chronic pulmonary disease (hazard ratio, 2.00, 95% confidence interval, 1.41-2.84; P <.001), peripheral vascular disease (hazard ratio, 1.58; 95% confidence interval, 1.05-2.37; P =.029), and atrial fibrillation (hazard ratio, 1.75; 95% confidence interval, 1.16-2.65; P =.008). Conclusions: SAVR in moderate-risk patients is currently performed with one half of the early predicted risk (2.8%) and a low likelihood of complications, including a 1.8% incidence of stroke. Patients counseled for randomization to transcatheter aortic valve insertion should be informed of the excellent early to mid-term outcomes of SAVR, particularly those without pulmonary impairment, peripheral vascular disease, or atrial fibrillation.

AB - Objective: To determine the contemporary outcomes of surgical aortic valve replacement (SAVR) in a moderate surgical risk population. Methods: We studied 502 consecutive adults who had undergone isolated SAVR from January 2002 to June 2011 for severe aortic valve stenosis with a Society of Thoracic Surgery predicted risk of mortality of 4% to 8%. We included concomitant coronary artery bypass and aortic annular enlargement but not other concomitant procedures. The updated Valve Academic Research Consortium definitions were used, as appropriate. Results: The median age was 80 years (range, 49-96), 323 (64.3%) had New York Heart Association class III-IV symptoms, and 101 (20.1%) had undergone previous coronary artery bypass grafting. The mean predicted risk of mortality was 5.6%. Concomitant coronary artery bypass grafting was performed in 270 (53.8%). Re-exploration for bleeding occurred in 29 (5.8%), stroke in 9 (1.8%), and vascular complications in 2 (0.4%). In the cohort, 14 early deaths (2.8%) occurred. During follow-up (1174 days), 175 patients died. Using multivariate logistic regression analysis, the significant independent predictors of mid-term death included chronic pulmonary disease (hazard ratio, 2.00, 95% confidence interval, 1.41-2.84; P <.001), peripheral vascular disease (hazard ratio, 1.58; 95% confidence interval, 1.05-2.37; P =.029), and atrial fibrillation (hazard ratio, 1.75; 95% confidence interval, 1.16-2.65; P =.008). Conclusions: SAVR in moderate-risk patients is currently performed with one half of the early predicted risk (2.8%) and a low likelihood of complications, including a 1.8% incidence of stroke. Patients counseled for randomization to transcatheter aortic valve insertion should be informed of the excellent early to mid-term outcomes of SAVR, particularly those without pulmonary impairment, peripheral vascular disease, or atrial fibrillation.

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