Abstract
ObjectiveThe 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.MethodsWe 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.ResultsWe 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).ConclusionThe 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.
Highlights
Aortic valve replacement is the treatment of choice in severe symptomatic aortic valve disease
Higher IHM rates were associated with advanced age, female sex, comorbidities, concomitant coronary artery bypass grafting (CABG), and the use of mechanical Surgical aortic valve replacement (SAVR)
The number of SAVRs performed in Spain has increased since 2001
Summary
Aortic valve replacement is the treatment of choice in severe symptomatic aortic valve disease. Surgical aortic valve replacement (SAVR) reduces mortality, provides symptom relief and increases quality of life at subsequent follow-up[1]. Continuous improvements in SAVR techniques and new technologies have recently been developed to facilitate the procedure and reduce operative times[2]. The range of available prostheses changed significantly during the last decades in favor of biological valve versus mechanical valve replacements[3]. A study using the National Inpatient Sample (NIS) found an increase in the use of bioprosthetic valves from 37.7% in 1998-2001 to 63.6% in 2007-2011[4]. Biological valves are increasingly implanted in younger patients due to a higher durability enabled by improved anticalcification treatment and the adverse events associated with mechanical prostheses[4,5]
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