Abstract:Objective: The 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. Methods: We 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. Results: We identified 86,578 patients who underwe… Show more
“…The observed mortality rate has outperformed the predicted mortality rate by nearly 50% in 2016–2018. The mortality rate in the United Kingdom has further reduced since the last report ( 13 ) and other reports in the literature ( 9 , 14 ).…”
Section: Discussionmentioning
confidence: 86%
“…Our study demonstrated that SAVR remains an effective treatment with low mortality for patients with isolated aortic valve disease. The number of patients with high-risk, octogenarians undergoing isolated SAVR, and those requiring redo surgery has reduced in recent years, likely due to the (13) and other reports in the literature (9,14).…”
Section: Discussionmentioning
confidence: 99%
“…The increased use of bioprostheses we observed reflects a similar trend in the literature. Jiménez-García et al ( 9 ) reported a five-fold use of bioprostheses from 2001 to 2015 using the Spanish National Hospital Discharge Database, although the age groups were not specified. Alkhouli et al ( 8 ) reported the age group-specific use of bio/mechanical prostheses in the United States using the Nationwide Inpatient Sample.…”
Section: Discussionmentioning
confidence: 99%
“…TAVR also provides an alternative to patients with the previous SAVR/TAVR with an option of valve-in-valve transcatheter aortic valve replacement (ViV TAVR). This has been suggested to result in a reduction in mechanical valve use worldwide ( 8 , 9 ).…”
ObjectiveSurgical aortic valve replacement (SAVR) is traditionally the gold-standard treatment in patients with aortic valve disease. The advancement of transcatheter aortic valve replacement (TAVR) provides an alternative treatment to patients with high surgical risks and those who had previous cardiac surgery. We aim to evaluate the trend, early clinical outcomes, and the choice of prosthesis use in isolated SAVR in the United Kingdom.MethodsAll patients (n = 79,173) who underwent elective or urgent isolated surgical aortic valve replacement (SAVR) from 1996 to 2018 were extracted from the National Adult Cardiac Surgery Audit database. Patients who underwent additional procedures and emergency or salvage SAVR were excluded from the study. Trend and clinical outcomes were investigated in the whole cohort. Patients who had previous cardiac surgery, high-risk groups (EuroSCORE II >4%), and predicted/observed mortality were evaluated. Furthermore, the use of biological prostheses in five different age groups, that are <50, 50–59, 60–69, 70–79, and >80, was investigated. Clinical outcomes between the use of mechanical and biological aortic valve prostheses in patients <65 years old were analyzed.ResultsThe number of isolated SAVR increased across the study period with an average of 4,661 cases performed annually after 2010. The in-hospital/30-day mortality rate decreased from 5.28% (1996) to 1.06% (2018), despite an increasing trend in EuroSCORE II. The number of isolated SAVR performed in octogenarians increased from 596 to 2007 (the first year when TAVR was introduced in the UK) to 872 in 2015 and then progressively decreased to 681 in 2018. Biological prosthesis usage increased across all age groups, particularly in the 60–69 group, from 24.59% (1996) to 81.87% (2018). There were no differences in short-term outcomes in patients <65 years old who received biological or mechanical prostheses.ConclusionSurgical aortic valve replacement remains an effective treatment for patients with isolated aortic valve disease with a low in-hospital/30-day mortality rate. The number of patients with high-risk and octogenarians who underwent isolated SAVR and those requiring redo surgery has reduced since 2016, likely due to the advancement in TAVR. The use of biological aortic prostheses has increased significantly in recent years in all age groups.
“…The observed mortality rate has outperformed the predicted mortality rate by nearly 50% in 2016–2018. The mortality rate in the United Kingdom has further reduced since the last report ( 13 ) and other reports in the literature ( 9 , 14 ).…”
Section: Discussionmentioning
confidence: 86%
“…Our study demonstrated that SAVR remains an effective treatment with low mortality for patients with isolated aortic valve disease. The number of patients with high-risk, octogenarians undergoing isolated SAVR, and those requiring redo surgery has reduced in recent years, likely due to the (13) and other reports in the literature (9,14).…”
Section: Discussionmentioning
confidence: 99%
“…The increased use of bioprostheses we observed reflects a similar trend in the literature. Jiménez-García et al ( 9 ) reported a five-fold use of bioprostheses from 2001 to 2015 using the Spanish National Hospital Discharge Database, although the age groups were not specified. Alkhouli et al ( 8 ) reported the age group-specific use of bio/mechanical prostheses in the United States using the Nationwide Inpatient Sample.…”
Section: Discussionmentioning
confidence: 99%
“…TAVR also provides an alternative to patients with the previous SAVR/TAVR with an option of valve-in-valve transcatheter aortic valve replacement (ViV TAVR). This has been suggested to result in a reduction in mechanical valve use worldwide ( 8 , 9 ).…”
ObjectiveSurgical aortic valve replacement (SAVR) is traditionally the gold-standard treatment in patients with aortic valve disease. The advancement of transcatheter aortic valve replacement (TAVR) provides an alternative treatment to patients with high surgical risks and those who had previous cardiac surgery. We aim to evaluate the trend, early clinical outcomes, and the choice of prosthesis use in isolated SAVR in the United Kingdom.MethodsAll patients (n = 79,173) who underwent elective or urgent isolated surgical aortic valve replacement (SAVR) from 1996 to 2018 were extracted from the National Adult Cardiac Surgery Audit database. Patients who underwent additional procedures and emergency or salvage SAVR were excluded from the study. Trend and clinical outcomes were investigated in the whole cohort. Patients who had previous cardiac surgery, high-risk groups (EuroSCORE II >4%), and predicted/observed mortality were evaluated. Furthermore, the use of biological prostheses in five different age groups, that are <50, 50–59, 60–69, 70–79, and >80, was investigated. Clinical outcomes between the use of mechanical and biological aortic valve prostheses in patients <65 years old were analyzed.ResultsThe number of isolated SAVR increased across the study period with an average of 4,661 cases performed annually after 2010. The in-hospital/30-day mortality rate decreased from 5.28% (1996) to 1.06% (2018), despite an increasing trend in EuroSCORE II. The number of isolated SAVR performed in octogenarians increased from 596 to 2007 (the first year when TAVR was introduced in the UK) to 872 in 2015 and then progressively decreased to 681 in 2018. Biological prosthesis usage increased across all age groups, particularly in the 60–69 group, from 24.59% (1996) to 81.87% (2018). There were no differences in short-term outcomes in patients <65 years old who received biological or mechanical prostheses.ConclusionSurgical aortic valve replacement remains an effective treatment for patients with isolated aortic valve disease with a low in-hospital/30-day mortality rate. The number of patients with high-risk and octogenarians who underwent isolated SAVR and those requiring redo surgery has reduced since 2016, likely due to the advancement in TAVR. The use of biological aortic prostheses has increased significantly in recent years in all age groups.
“…Comparing the predictors for the 30-day composite endpoint, there were important differences between first-time and repeat AVR procedures. Although female sex, age, congestive heart failure (CHF), coronary artery disease, cerebrovascular disease, and renal function were previously documented to impact first-time SAVR patients' adverse clinical outcomes [31,32] , these were not identified in the present r-AVR study. Similarly, pulmonary hypertension, renal function, and diabetes had been found to be predictors of post-TAVR adverse clinical outcomes in a prior study [33] .…”
Aim: The ability to predict outcomes can help clinicians to better triage and treat stroke patients. We aimed to build prediction models using clinical data at admission and discharge to assess predictors highly relevant to stroke outcomes. Methods: A total of 37,094 patients from the Taiwan Stroke Registry (TSR) were enrolled to ascertain clinical variables and predict their mRS outcomes at 90 days. The performances (i.e., the area under the curves (AUCs)) of these independent predictors identified by logistic regression (LR) based on clinical variables were compared. Results: Several outcome prediction models based on different patient subgroups were evaluated, and their AUCs based on all clinical variables at admission and discharge were 0.85-0.88 and 0.92-0.96, respectively. After feature selections, the input features decreased from 140 to 2-18 (including age of onset and NIHSS at admission) and from 262 to 2-8 (including NIHSS at discharge and mRS at discharge) at admission and discharge, respectively. With only a few selected key clinical features, our models can provide better performance than those previously reported in the literature. Conclusion: This study proposed high performance prognostics outcome prediction models derived from a population-based nationwide stroke registry even with reduced LR-selected clinical features. These key clinical features can help physicians to better focus on stroke patients to triage for best outcome in acute settings.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.