Impact of Non-Valvular Non-Coronary Concomitant Procedures on Outcomes of Surgical Aortic Valve Replacement in Intermediate Risk Patients.

Fanar Mourad,Daniel Wendt,Matthias Thielmann,Yacine Elhmidi,Sharaf-Eldin Shehada,Philipp Marx,Marinela Jasarevic,Ali Haddad,Ender Demircioglu,Arjang Ruhparwar,Janine Nowak,Bastian Schmack,Mohamed Elbarraki

doi:10.3390/jcm10235592

Abstract

Introduction: advanced age and concomitant procedures could increase the risk of perioperative complications during surgical aortic valve replacement (SAVR). We aimed to evaluate results of elderly patients undergoing SAVR and evaluate the impact of concomitant non-valvular, non-coronary procedures on the outcomes. Methods: A retrospective single-centre study, evaluating 464 elderly patients (mean age = 75.6 ± 4 years) undergoing either isolated-SAVR (I-SAVR = 211) or combined-SAVR (C-SAVR = 253) between 01/2007 and 12/2017. Combined-SAVR involved non-valvular, non-coronary procedures. Study endpoints are postoperative results concerning the VARC-II criteria, valve dysfunction, long-term freedom from redo-AVR and survival. Results: males were 52.8%. Patients had an intermediate risk profile (mean EuroSCORE-II (%) 5.2 ± 5). Postoperative results reported no significant differences in incidence of re-exploration for bleeding (6.6% vs. 6.7%, p = 1.0), stroke (0.9% vs. 0.4%, p = 0.59), dialysis (6.2% vs. 9.5%, p = 0.23) and pacemaker implantation (3.3% vs. 2.8%, p = 0.79) between I-SAVR and C-SAVR groups. Thirty-day (2.4% vs. 7.1% p = 0.03), one-year (5.7% vs. 13.8%, p = 0.003) and overall mortality (24.6% vs. 37.5%, p = 0.002) were lower in the isolated-SAVR group. Re-AVR was indicated in 1.7% of patients due to endocarditis. Conclusions: SAVR in elderly patients offers good outcomes with increased life quality and rare re-operation for structural valvular deterioration. Mortality rates were significantly higher when SAVR was combined with another “non-valvular, non-coronary” procedure.

Highlights

Licensee MDPI, Basel, Switzerland.Age distribution of cardiac surgery patients in Germany shows an increased shift toward an elderly population
Patients in the I-surgical aortic valve replacement (SAVR) presented with advanced NYHA classifications NYHA
SAVR in intermediate risk patients was associated with acceptable early and long-term outcome with increased life quality and re-operation for structural prosthesis deterioration was rare

Summary

Introduction

Age distribution of cardiac surgery patients in Germany shows an increased shift toward an elderly population. In 2019, the German Heart Surgery Report reported that more than 53% of cardiac procedures were performed in patients older than 70 years during the last ten years [1]. Were aortic valve procedures; most of them (59.2%) were either isolated or combined surgical aortic valve replacement (SAVR) [1]. Trans-catheter aortic valve implantation (TAVI) has been more frequently adopted in isolated aortic valve procedure in high-risk patients, in intermediate risk and in low risk patients [4,5]. In Germany, the number of TAVI procedures increased from 2198 in 2009 to 13,279 in 2018, which represents 57.5% of the isolated aortic valve procedures [1]

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