Key result
Surgical aortic valve replacement in the recent era (2013-2018) was associated with lower in-hospital mortality compared to the early era (1.22% vs 2.20%; OR 0.668, 95% CI 0.466-0.958).
Why the study?
Demographic changes and postoperative outcomes of SAVR since the advent of TAVI in France were assessed.
Does surgical aortic valve replacement in the modern era (post-TAVI approval) improve early outcomes compared to the pre-TAVI era in patients with aortic stenosis?
Cohort (n=27,398)
Yes
Does surgical aortic valve replacement in the modern era (post-TAVI approval) improve early outcomes compared to the pre-TAVI era in patients with aortic stenosis?
Odds Ratio: 0.668 (95% CI 0.466–0.958)
Absolute Event Rate: 1.22% vs 2.2%
p-value: p=≤0.005
In the modern era following TAVI approval, surgical aortic valve replacement is associated with significantly reduced in-hospital and 30-day mortality compared to the pre-TAVI era.
Observational SAVR mortality reduction post-TAVI should not change practice; leaves open confounding by selection or technique shifts.
OBJECTIVE: We sought to assess the demographic changes and postoperative outcomes of surgical aortic valve replacement (SAVR) in recent years since the advent of trans-catheter aortic valve implantation (TAVI) in France. METHODS: Demographic, surgical data, and early outcomes of patients undergoing SAVR for AS were reviewed from The French registry EPICARD before (2007-2012) and after (2013-2018) approval of TAVI by French health authorities. We included patients with less than 20% of missing data per variable and per patient. Univariate and multivariate analysis were conducted to assess for risk factors of mortality and acute kidney failure (AKF) requiring renal replacement therapy (RRT). RESULTS: A total of 27,398 patients from the EPICARD registry were included: 8819, in the early cohort (2007-2012) and 18,579 in the recent cohort (2013-2018). In-hospital and 30-day mortality rates were lower in the recent cohort compared to the early cohort, respectively 1.22% versus 2.20 (p < .001) and 1.22% versus 2.34% (p < .001). The bioprosthesis-to-mechanical prosthesis ratio significantly increased over the time: from 5.3 to 8.1. In the recent cohort, rates of postoperative blood transfusions, prolonged mechanical ventilation, and AKF requiring RRT were lower. In-hospital and 30-day mortality risks were decreased in the recent cohort, with odds ratio respectively of 0.668 [0.466-0.958] and 0.66 [0.460-0.945] in multivariate (p ≤ .005) and univariate analysis (p < .001). Risk of AKF with RRT was unchanged. CONCLUSION: This nationwide study from the French registry EPICARD shows significant reduced hospital mortality and persistent favourable early outcomes of SAVR since TAVI implementation.
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Guimaron et al. (2021) conducted a cohort in Aortic stenosis requiring surgical aortic valve replacement (n=27,398). Recent era (2013-2018) surgical aortic valve replacement vs. Early era (2007-2012) surgical aortic valve replacement was evaluated on In-hospital mortality (OR 0.668, 95% CI 0.466-0.958, p=≤0.005). Surgical aortic valve replacement in the recent era (2013-2018) was associated with lower in-hospital mortality compared to the early era (1.22% vs 2.20%; OR 0.668, 95% CI 0.466-0.958).
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