Aortic valve surgery: Marked increases in volume and significant decreases in mechanical valve use—an analysis of 41,227 patients over 5 years from the Society for Cardiothoracic Surgery in Great Britain and Ireland National database

Abstract

Aortic valve replacement is accepted as a standard treatment for aortic stenosis and regurgitation. To help plan the national requirement for conventional and catheter-based procedures, we have analyzed the Society for Cardiothoracic Surgery in Great Britain and Ireland audit database to look at changes in practice over time. All patients undergoing conventional aortic valve replacement with or without coronary artery surgery from April 2004 to March 2009 were included. The main outcome measures were changes in the number, characteristics, operative details, and in-hospital mortality. We have looked particularly at trends and outcomes in elderly and high-risk patients (EuroSCORE of 10 or more) who may now be considered for percutaneous aortic valve insertion. A total of 41,227 patients underwent aortic valve surgery over 5 years with an in-hospital mortality of 4.1%. The annual number increased from 7396 in 2004-2005 to 9333 in 2008-2009, with significant increases (P < .0005) in mean age (68.8-70.2 years), the proportion of patients with aortic stenosis (62.4%-65.1%), octogenarians (13.6%-18.4%), high-risk patients (24.6%-27.7%), and those receiving biological valves (65.4%-77.8%). The incidence of permanent cerebrovascular accident was 1.2% and 1.0% in patients having only an aortic valve replacement. The dialysis rate was 4.5% and the reoperation rate for bleeding was 6.6%. Overall mortality decreased from 4.4% in 2004-2005 to 3.7% in 2008-2009. Survival to a mean follow-up of 2.5 years was 89%. We have seen a large increase in annual volume of aortic valve replacements, with more patients undergoing surgery for aortic stenosis and an increase in surgery in the elderly and high-risk patients.