PT  - JOURNAL ARTICLE
AU  - Jahangiri, Marjan
AU  - Bilkhu, Rajdeep
AU  - Embleton-Thirsk, Andrew
AU  - Dehbi, Hakim-Moulay
AU  - Mani, Krishna
AU  - Anderson, Jon
AU  - Avlonitis, Vassilios
AU  - Baghai, Max
AU  - Birdi, Inderpaul
AU  - Booth, Karen
AU  - Bose, Amal
AU  - Briffa, Norman
AU  - Buchan, Keith
AU  - Bhudia, Sunil
AU  - Cale, Alex
AU  - Deglurkar, Indu
AU  - Farid, Shakil
AU  - Hadjinikolaou, Leonidas
AU  - Jarvis, Martin
AU  - Javadpour, Seyed Hossein
AU  - Jeganathan, Reubendra
AU  - Kuduvalli, Manoj
AU  - Lall, Kulvinder
AU  - Mascaro, Jorge
AU  - Mehta, Dheeraj
AU  - Ohri, Sunil
AU  - Punjabi, Prakash
AU  - Venkateswaran, Rajamiyer
AU  - Ridley, Paul
AU  - Satur, Christopher
AU  - Stoica, Serban
AU  - Trivedi, Uday
AU  - Zaidi, Afzal
AU  - Yiu, Patrick
AU  - Moorjani, Narain
AU  - Kendall, Simon
AU  - Freemantle, Nick
TI  - Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database
AID  - 10.1136/bmjopen-2020-046491
DP  - 2021 Oct 01
TA  - BMJ Open
PG  - e046491
VI  - 11
IP  - 10
4099  - http://bmjopen.bmj.com/content/11/10/e046491.short
4100  - http://bmjopen.bmj.com/content/11/10/e046491.full
SO  - BMJ Open2021 Oct 01; 11
AB  - Objectives To date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore ‘real-world’ practice.Design Retrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants’ demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed.Setting 27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis.Participants 31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG.Results In-hospital mortality for isolated SAVR was 1.9% (95% CI 1.6% to 2.1%) and was 2.4% for AVR+CABG. Mortality by age category for SAVR only were: <60 years=2.0%, 60–75 years=1.5%, >75 years=2.2%. For SAVR+CABG these were; 2.2%, 1.8% and 3.1%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3%, in intermediate risk 1% and for high risk 3.9%. 74.3% of the operations were elective, 24% urgent and 1.7% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9% and 1.1%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes.Conclusions Surgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease.Data are available on reasonable request. Requests on data sharing can be made by contacting the corresponding author. Data will be shared after review and approval by the authors and terms of collaboration will be reached together with a signed data access agreement.