Early and Long-term Outcomes of Aortic Valve Replacement Surgery in Low- and Intermediate-risk Patients

pp. 190-195

Abstract

Background: With the introduction of new percutaneous techniques for the treatment of severe aortic stenosis, it is important to define which group of patients will benefit more with this new therapeutic option.

Objective: The aim of this study was to analyze the outcomes of aortic valve replacement in low/intermediate risk patients in our setting to establish a reference point for the application of this new therapeutic technology.

Methods: Early and long-term postoperative outcomes were analyzed in 520 patients over 70 years of age, with severe aortic stenosis with or without associated coronary heart disease who were operated on between January 2010 and January 2017. Four hundred and forty-five patients were identified as low risk (STS <4) and 75 as intermediate risk (STS=4-8) patients; PROM STS for the overall group of patients was 2.5.

Results: Mean population age was 76.8 ±4.7 years, and most patients were men. Total in-hospital mortality was 3.1%: 2.7% for low-risk patients and 5.3% for intermediate-risk patients. The incidence of stroke was 0.6% and the need for definitive pacemaker 3.5%. Five-year survival for low-risk patients was 88.5% vs. 67.8% for intermediate-risk patients (logrank test <0.001). At 5 years, freedom from readmission for low-risk patients and intermediate-risk patients was 91.1% and 91.9%, respectively (p=ns) and freedom from reintervention was 98.7 and 97.7%, respectively (p=ns).

Conclusion: Aortic valve replacement in low/intermediate risk patients has low incidence of in-hospital morbidity and mortality, low rate of stroke and need for definitive pacemaker, and low frequency of events at a 5-year follow-up.