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Changes in Risk Profile and Outcomes of Patients Undergoing Surgical Aortic Valve Replacement From the Pre- to Post-Transcatheter Aortic Valve Replacement Eras.

Publication ,  Journal Article
Englum, BR; Ganapathi, AM; Schechter, MA; Harrison, JK; Glower, DD; Hughes, GC
Published in: Ann Thorac Surg
January 2016

BACKGROUND: With initiation of transcatheter aortic valve replacement (TAVR) programs, centers may see changes in surgical aortic valve replacement (SAVR) populations and related outcomes because of more high-risk patients undergoing TAVR rather than SAVR. Little data exist on the potential changes in the risk profiles and outcomes of SAVR patients from the pre- to post-TAVR eras. As such, this study sought to evaluate changes in the SAVR population at a tertiary referral center after TAVR program initiation. METHODS: Using a single-center valve surgical database, annual volume, patient characteristics, operative details, and predicted and observed mortality for patients undergoing isolated SAVR or SAVR + coronary artery bypass grafting (CABG) from 2006 to 2013 were evaluated. Patients were divided into 3 eras: (1) pre-TAVR (January 2006-June 2009), (2) transition (July 2009-March 2011), and (3) TAVR (April 2011-June 2013). The primary analysis compared predicted and observed mortality in pre-TAVR and TAVR eras. RESULTS: From 2006 to 2013, 1,380 SAVR patients were identified, with 505 (36.6%), 330 (23.9%), and 545 (39.5%) patients from the pre-TAVR, transition, and TAVR eras, respectively. SAVR case volume increased from 131 to 256 cases per year (95.4% increase) from the pre-TAVR to the post-TAVR eras. Predicted risk of mortality (PROM) for SAVR patients from the pre-TAVR to TAVR eras by The Society of Thoracic Surgeons (STS)-PROM was stable near 3.8% (p = 0.82). Crude 30-day SAVR mortality trended down from 2.8% in the pre-TAVR era to 1.5% in the post-TAVR era (p = 0.23). CONCLUSIONS: Consistent with previous studies, initiation of a TAVR program was associated with increased SAVR volume. Risk profiles for SAVR patients in the TAVR era remained similar by the STS-PROM, indicating generally stable risk among surgical patients after launching a TAVR program. These data suggest that significant changes in the risk profiles of SAVR patients should not be expected with the initiation of a TAVR program. Further research will need to reevaluate these changes once TAVR becomes more widely available.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

January 2016

Volume

101

Issue

1

Start / End Page

110 / 117

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Respiratory System
  • Prospective Studies
  • North Carolina
  • Middle Aged
  • Male
 

Citation

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Englum, B. R., Ganapathi, A. M., Schechter, M. A., Harrison, J. K., Glower, D. D., & Hughes, G. C. (2016). Changes in Risk Profile and Outcomes of Patients Undergoing Surgical Aortic Valve Replacement From the Pre- to Post-Transcatheter Aortic Valve Replacement Eras. Ann Thorac Surg, 101(1), 110–117. https://doi.org/10.1016/j.athoracsur.2015.06.083
Englum, Brian R., Asvin M. Ganapathi, Matthew A. Schechter, J Kevin Harrison, Donald D. Glower, and G Chad Hughes. “Changes in Risk Profile and Outcomes of Patients Undergoing Surgical Aortic Valve Replacement From the Pre- to Post-Transcatheter Aortic Valve Replacement Eras.Ann Thorac Surg 101, no. 1 (January 2016): 110–17. https://doi.org/10.1016/j.athoracsur.2015.06.083.
Englum BR, Ganapathi AM, Schechter MA, Harrison JK, Glower DD, Hughes GC. Changes in Risk Profile and Outcomes of Patients Undergoing Surgical Aortic Valve Replacement From the Pre- to Post-Transcatheter Aortic Valve Replacement Eras. Ann Thorac Surg. 2016 Jan;101(1):110–7.
Englum, Brian R., et al. “Changes in Risk Profile and Outcomes of Patients Undergoing Surgical Aortic Valve Replacement From the Pre- to Post-Transcatheter Aortic Valve Replacement Eras.Ann Thorac Surg, vol. 101, no. 1, Jan. 2016, pp. 110–17. Pubmed, doi:10.1016/j.athoracsur.2015.06.083.
Englum BR, Ganapathi AM, Schechter MA, Harrison JK, Glower DD, Hughes GC. Changes in Risk Profile and Outcomes of Patients Undergoing Surgical Aortic Valve Replacement From the Pre- to Post-Transcatheter Aortic Valve Replacement Eras. Ann Thorac Surg. 2016 Jan;101(1):110–117.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

January 2016

Volume

101

Issue

1

Start / End Page

110 / 117

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Respiratory System
  • Prospective Studies
  • North Carolina
  • Middle Aged
  • Male