Morbidity outcomes after surgical aortic valve replacement

Abstract

Objective: In patients with mild to moderate operative risk, surgical aortic valve replacement (SAVR) is still the preferred treatment for patients with severe symptomatic aortic stenosis (AS). Aiming to broaden the knowledge of postsurgical outcomes, this study reports a broad set of morbidity outcomes following surgical intervention.

Methods: Our cohort comprised 442 patients referred for severe AS; 351 had undergone SAVR, with the remainder (91) not operated on. All patients were evaluated using the 6-minute walk test (6MWT), were assigned a New York Heart Association class (NYHA) and Canadian Cardiovascular Society class (CCS), with additional scores for health-related quality of life (HRQoL), cognitive function (Mini-Mental State Examination (MMSE)) and myocardial remodelling (at inclusion and at 1-year follow-up). Adverse events and mortality were recorded.

Results: Three-year survival after SAVR was 90.0%. SAVR was associated with an improved NYHA class, CCS score and HRQoL, and provoked reverse ventricular remodelling. The 6MWT decreased, while the risks of major adverse cardiovascular events (death, non-fatal stroke/transient ischaemic attack or myocardial infarction) and all-cause hospitalisation (incidence rate per 100 patient-years) were 13.5 and 62.4, respectively. The proportion of cognitive disability measured by MMSE increased after SAVR from 3.2% to 8.8% (p=0.005). Proportion of patients living independently at home, having attained NYHA class I, was met by 49.1% at 1 year. Unoperated individuals had a poor prognosis in terms of any outcome.

Conclusion: This study provides knowledge of outcomes beyond what is known about the mortality benefit after SAVR to provide insight into the morbidity burden of modern-day SAVR.

Keywords: Aortic valvne disease; Quality of care and outcomes; Surgery -valve.

Figure 1

Patient flow diagram. MT, medical treatment; SAVR, surgical aortic valve replacement; TAVI, transcatheter aortic valve implantation.

Figure 2

Change in symptoms in operated and unoperated patients 1 year following evaluation of surgical AVR. Pie charts display change from baseline to follow-up in NYHA and CCS class for operated and unoperated patients who had data on both time points. Improvement or worsening is defined as at least one class change. AVR, aortic valve replacement; CCS, Canadian Cardiovascular Society; NYHA, New York Heart Association.

Figure 3

Overall 3-year survival in operated and unoperated patients with severe aortic stenosis. AVR, aortic valve replacement.

Figure 4

Event-free survival from major adverse cardiovascular event (MACE) in operated and unoperated patients with severe aortic stenosis. MACE is defined as time to all-cause death, transient ischaemic attack (TIA), stroke or myocardial infarction (MI). AVR, aortic valve replacement.