Contemporary trends in the surgical management of aortic valve disease

Abstract

Introduction: Aortic valve pathology carries a high mortality burden. Its incidence is growing in proportion to the continuous ageing of the population. Surgery remains the gold standard in the treatment of severe aortic valve disease. Methods: We performed a retrospective analysis of the University Hospital Center Zagreb's cardiac surgical database from 2009 to 2020, focusing on surgical aortic valve replacement (SAVR). We dichotomized patients with respect to the date of their surgical procedures into two eras. Group 1 included patients operated from 2009-2014, whereas Group 2 included patients operated on from 2015-2020. Results: A total of 1012 SAVRs were identified during the study period. The procedural volume over the two identical 6-year time periods increased in the latter era from 413 to 598. When comparing groups 1 and 2, we have observed in increase in the number of patients with diabetes (19% vs. 26%, P=0.015) and coronary artery disease (14% vs. 18%, P=0.099). The composite risk assessment score increased significantly from 3.0±2.4 to 3.2±2.7, P=0.023. Despite an increase in the comorbidity burden of the targeted patient population, the periprocedural mortality remained the same (2.1% vs 2.5%, P=0.835). The per-patient averaged volume of transfused packed red blood cells decreased from 839±954 to 614±821 ml, P<0.001. An increase in the proportion of tissue valve implantations in comparison to mechanical prostheses was also noted in the present era (58% vs 68%, P=0.001) Conclusion: Despite an increasingly more complex patient population referred for SAVR in the contemporary era, the results have remained excellent. The introduction of transcatheter methods should measure up to the surgical standard.