RT Journal Article
SR Electronic
T1 Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e046491
DO 10.1136/bmjopen-2020-046491
VO 11
IS 10
A1 Jahangiri, Marjan
A1 Bilkhu, Rajdeep
A1 Embleton-Thirsk, Andrew
A1 Dehbi, Hakim-Moulay
A1 Mani, Krishna
A1 Anderson, Jon
A1 Avlonitis, Vassilios
A1 Baghai, Max
A1 Birdi, Inderpaul
A1 Booth, Karen
A1 Bose, Amal
A1 Briffa, Norman
A1 Buchan, Keith
A1 Bhudia, Sunil
A1 Cale, Alex
A1 Deglurkar, Indu
A1 Farid, Shakil
A1 Hadjinikolaou, Leonidas
A1 Jarvis, Martin
A1 Javadpour, Seyed Hossein
A1 Jeganathan, Reubendra
A1 Kuduvalli, Manoj
A1 Lall, Kulvinder
A1 Mascaro, Jorge
A1 Mehta, Dheeraj
A1 Ohri, Sunil
A1 Punjabi, Prakash
A1 Venkateswaran, Rajamiyer
A1 Ridley, Paul
A1 Satur, Christopher
A1 Stoica, Serban
A1 Trivedi, Uday
A1 Zaidi, Afzal
A1 Yiu, Patrick
A1 Moorjani, Narain
A1 Kendall, Simon
A1 Freemantle, Nick
YR 2021
UL http://bmjopen.bmj.com/content/11/10/e046491.abstract
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.