Key result
Mechanical SAVR is linked to ~67% higher in-hospital mortality versus bioprosthetic valves.
Why the study?
To examine trends in incidence, in-hospital outcomes, and factors associated with in-hospital mortality among patients undergoing SAVR according to the type of implanted valve.
Does mechanical SAVR compared to bioprosthetic SAVR affect in-hospital mortality in patients undergoing surgical aortic valve replacement?
Observational (n=86,578)
Yes
Does mechanical SAVR compared to bioprosthetic SAVR affect in-hospital mortality in patients undergoing surgical aortic valve replacement?
Odds Ratio: 1.67 (95% CI 1.57–1.77)
Absolute Event Rate: 7.44% vs 6%
p-value: p=<0.05
Between 2001 and 2015 in Spain, SAVR utilization increased with a shift towards bioprosthetic valves, which were associated with lower in-hospital mortality compared to mechanical valves.
OBJECTIVE: The aims of this study were to examine the incidence and in-hospital outcomes of surgical aortic valve replacement (SAVR) and to identify factors associated with in-hospital mortality (IHM) among patients according to the type of implanted valve used in SAVR. METHODS: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001-2015. We included patients who had SAVR listed as a procedure in their discharge report. RESULTS: We identified 86,578 patients who underwent SAVR (52.78% mechanical and 47.22% bioprosthetic). Incidence of SAVR coding increased significantly from 11.95 cases per 100,000 inhabitants in 2001 to 17.92 in 2015 (P<0.001). Age and comorbidities increased over time (P<0.001). There was a significant increase in the frequency of concomitant coronary artery bypass grafting (CABG) and in the use of pacemaker implantation. The use of mechanical SAVR decreased and the use of bioprosthetic valves increased over time. IHM decreased over time (from 8.13% in 2001-05 to 5.39% in 2011-15). Patients who underwent mechanical SAVR had higher IHM than those who underwent bioprosthetic SAVR (7.44% vs. 6%; P<0.05). Higher IHM rates were associated with advanced age, female sex, comorbidities, concomitant CABG, and the use of mechanical SAVR (OR 1.67; 95% CI 1.57-1.77). CONCLUSION: The number of SAVRs performed in Spain has increased since 2001. The use of mechanical SAVR has decreased and the use of bioprosthetic valves has increased over time. IHM has decreased over time for both types of valves and despite a concomitant increase in age and comorbidities of patients during the same period.
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Jiménez‐García et al. (2020) conducted an observational in Surgical aortic valve replacement (n=86,578). Mechanical SAVR vs. Bioprosthetic SAVR was evaluated on In-hospital mortality (OR 1.67, 95% CI 1.57-1.77, p=<0.05). Mechanical surgical aortic valve replacement was associated with higher in-hospital mortality compared to bioprosthetic valves (7.44% vs. 6%; OR 1.67, 95% CI 1.57-1.77).
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