Long-Term Outcomes Following Surgical Aortic Bioprosthesis Implantation

Abstract

Background: Few data exist on long-term outcomes and structural valve degeneration (SVD) in consecutive unselected patients undergoing surgical aortic valve replacement (SAVR).

Objectives: The goal of this study was to determine the long-term outcomes of a contemporary cohort of consecutive unselected SAVR recipients with a focus on evaluating clinical outcomes and SVD based on echocardiographic criteria.

Methods: A total of 672 consecutive patients (mean age: 72 ± 8 years; 61.5% male) undergoing SAVR with a bioprosthesis between 2002 and 2004 were included. Baseline and follow-up data were prospectively collected in a dedicated database. Baseline post-operative echocardiographic data were obtained in the 624 patients alive at hospital discharge and in 209 patients at 10 years (87% of the patients at risk). SVD was defined as subclinical (increase >10 mm Hg in mean transvalvular gradient + decrease >0.3 cm² in valve area and/or new-onset mild or moderate aortic regurgitation) and clinically relevant (increase >20 mm Hg in mean transvalvular gradient + decrease >0.6 cm² in valve area and/or new-onset moderate-to-severe aortic regurgitation).

Results: At a median follow-up of 10 years (interquartile range: 5 to 13 years), 432 patients (64.3%) had died. Older age, left ventricular dysfunction, atrial fibrillation, chronic obstructive pulmonary disease, greater body mass index, and diabetes mellitus were associated with an increased mortality risk (p < 0.05 for all). Clinically relevant SVD occurred in 6.6% of patients; 30.1% of patients had subclinical SVD. A greater body mass index and the use of a specific aortic bioprosthesis were independently associated with clinically relevant SVD (p < 0.05 for both), and 83% of these patients underwent aortic valve reintervention (valve-in-valve transcatheter aortic valve replacement in 44% of them).

Conclusions: The 10-year mortality rate in elderly SAVR recipients of a bioprosthetic valve was considerable, chiefly determined by their older age and the presence of comorbidities. Clinically relevant SVD was infrequent, but close to one third of the population exhibited subclinical SVD. These results provide contemporary data on long-term clinical outcomes and SVD post-SAVR, and they should be taken into consideration when evaluating late clinical outcomes and valve durability after transcatheter aortic valve replacement.

Keywords: aortic stenosis; structural valve degeneration; surgical aortic valve replacement.