A retrospective study on the trends in surgical aortic valve replacement outcomes in the post-transcatheter aortic valve replacement era

Johnny Chahine; Zeina Jedeon; Jacob Fiocchi; Andrew Shaffer; Ryan Knoper; Ranjit John; Demetris Yannopoulos; Ganesh Raveendran; Sergey Gurevich

doi:10.1002/hsr2.660

A retrospective study on the trends in surgical aortic valve replacement outcomes in the post-transcatheter aortic valve replacement era

Health Sci Rep. 2022 May 22;5(3):e660. doi: 10.1002/hsr2.660. eCollection 2022 May.

Authors

Johnny Chahine¹, Zeina Jedeon², Jacob Fiocchi², Andrew Shaffer³, Ryan Knoper³, Ranjit John³, Demetris Yannopoulos¹, Ganesh Raveendran¹, Sergey Gurevich¹

Affiliations

¹ Department of Cardiovascular Disease University of Minnesota Medical School Minneapolis Minnesota USA.
² Department of Internal Medicine University of Minnesota Medical School Minneapolis Minnesota USA.
³ Department of Cardiothoracic Surgery University of Minnesota Medical School Minneapolis Minnesota USA.

Abstract

Background and aims: Transcatheter aortic valve replacement (TAVR) is the mainstay of treatment of inoperable and severe high-risk aortic stenosis and is noninferior to surgical aortic valve replacement (SAVR) for low-risk and intermediate-risk patients as well. We aim to compare the valve size, area, and transaortic mean gradients in SAVR patients before and after the implementation of TAVR since being approved by the Food and Drug Administration in 2011.

Methods: Patients who underwent a bioprosthetic SAVR placement were divided into two groups based on the date of procedure: the early pre-TAVR implementation group (years 2011-2012) and the contemporary post-TAVR group (years 2019-2020). The primary endpoint was the mean gradient across the aortic valve within 16 months of surgery. The secondary endpoints included the difference in valve size and various aortic valve echocardiographic variables.

Results: One hundred and thirty patients had their valves replaced in the years 2011-2012 and 134 in the years 2019-2020. The early group had a significantly higher mean gradient (median of 13 mmHg [interquartile range, IQR: 9.3-18] vs. 10 mmHg [IQR: 7.5-13.1], p = 0.001) and a smaller median effective orifice area index (0.8 cm²/m² [IQR: 0.6-1] vs. 1.1 cm²/m² [IQR: 0.8-1.3], p < 0.001). The median valve size was significantly smaller in the early group (median of 21 mm [IQR: 21-23] vs. 23 mm [IQR: 22.5-25], p < 0.001).

Conclusion: In the contemporary era, surgical patients receive larger valves which translates into lower mean gradients, larger valve area, and lower rates of patient-prosthesis mismatch than in previous years before the routine introduction of TAVR.

Keywords: aortic stenosis; outcomes; surgical aortic valve replacement; transcatheter aortic valve replacement.