Isolated Aortic Valve Replacement: Decade Trends of in-Hospital Mortality and Case-Mix Following the Institution of the Heart Team

Abstract

Background and aim: The concept of Heart Team (HT) has been a major advancement for decision making in cardiovascular medicine. The aim of the study is to analyse trends of in-hospital mortality and case-mix among patients who underwent to isolated aortic valve replacement (iAVR) before and after HT institution. Methods: We analysed data of 1092 adult patients who underwent iAVR at our hospital between January 2005 and December 2016. They represented 12.3% of the overall surgical case-load of the same period. During the second-half of 2008 HT has been implemented at our hospital. Results: During 2005–2016 period in-hospital mortality following iAVR was 1,8%. In-hospital mortality decreased from 3,9% (2005–2008) to 0,8% (2009–2016) (p .0004). Mean number of iAVR/year increased from 75,5 (2005–2008) to 99,1 (2009–2016). The prevalence of octogenarians patients increased from 11,5% (2005–2008) to 16,5% (2009–2016) (p.00001); in-hospital mortality decreased from 8,8% to 1,5% (p .02) among them. Conclusions: Following the institution of HT at our hospital, we observed a significant decrease of in-hospital mortality following iAVR, also in elderly patients. Volume of iAVR and octogenarians patients significantly increased. It is likely that surgical results benefited from the discussion of cases and the availability of transcatheter techniques for high-risk patients.