Key result
Isolated surgical aortic valve replacement showed a significant decrease in in-hospital mortality from 2.9% in 2000-2005 to 0.7% in 2012-2017 (P=0.0001), whereas combined SAVR and CABG did not.
Why the study?
Continuous improvements in SAVR management may have enhanced surgical outcomes, and analyzing mortality and morbidity trends could provide benchmarking insights for TAVI indications.
Has in-hospital mortality improved over time for patients undergoing surgical aortic valve replacement?
Observational (n=4,300)
No
Has in-hospital mortality improved over time for patients undergoing surgical aortic valve replacement?
Answers are grounded in this paper and cite their sources.
In-hospital mortality for isolated surgical aortic valve replacement has significantly decreased over a 17-year period, reaching 0.7% in the contemporary era, providing an important benchmark for TAVI comparisons.
OBJECTIVES: Continuous improvement in the management of patients undergoing surgical aortic valve replacement (SAVR) may have considerably enhanced surgical outcomes including in-hospital mortality and perioperative complications. We aimed to analyse in-hospital mortality and morbidity trends in patients undergoing SAVR in a single centre to provide insights for future benchmarking for transcatheter aortic valve implantation indications. METHODS: This was a retrospective study of prospectively collected data from patients undergoing either isolated SAVR or combined with coronary artery bypass grafting (CABG) at the Bristol Heart Institute, UK, from January 2000 to December 2017. Baseline characteristics were extracted and analysed across 3 different eras (2000-2005, 2006-2011 and 2012-2017). Risk-adjusted time trend was obtained from univariate and multivariate logistic regression including all baseline characteristics. RESULTS: A total of 2719 patients (63.2%) underwent isolated SAVR, and 1581 (36.8%) underwent combined CABG and SAVR during the study period. For patients undergoing SAVR, in-hospital mortality decreased from 2.9% in 2000-2005 to 0.7% in 2012-2017 (risk-adjusted time trend 0.0001). Hospital mortality in patients aged 75-79 and ≥80 years decreased from 5.6% and 5.3% to 0.4% and 2.2%, respectively. Mortality after combined SAVR and CABG did not significantly decrease (from 3.9% in 2000-2005 to 3.5% in 2012-2017; risk-adjusted time trend = 0.62). However, in patients aged ≥80 years, index hospitalization mortality showed a decreasing non-significant trend from 9.8% to 4.8%. CONCLUSIONS: Our findings support the hypothesis that mortality and morbidity rates following SAVR have significantly improved over the years, including for patients at high risk.
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Dimagli et al. (2020) conducted an observational in Aortic valve disease requiring surgical replacement (n=4,300). Surgical aortic valve replacement (SAVR) in 2012-2017 vs. SAVR in 2000-2005 was evaluated on In-hospital mortality for isolated SAVR (p=0.0001). Isolated surgical aortic valve replacement showed a significant decrease in in-hospital mortality from 2.9% in 2000-2005 to 0.7% in 2012-2017 (P=0.0001), whereas combined SAVR and CABG did not.
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