학술논문
Age-Stratified Surgical Aortic Valve Replacement for Aortic Stenosis.
Document Type
Academic Journal
Author
Mehta CK; Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois. Electronic address: christopher.mehta@nm.org.; Liu TX; Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois.; Bonnell L; The Society of Thoracic Surgeons Research and Analytic Center, Chicago, Illinois.; Habib RH; The Society of Thoracic Surgeons Research and Analytic Center, Chicago, Illinois.; Kaneko T; Division of Cardiac Surgery, Washington University in St Louis, St Louis, Missouri.; Flaherty JD; Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois.; Davidson CJ; Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois.; Thomas JD; Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois.; Rigolin VH; Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois.; Bonow RO; Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois.; Pham DT; Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois.; Johnston DR; Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois.; McCarthy PM; Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois.; Malaisrie SC; Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois.
Source
Publisher: Elsevier Country of Publication: Netherlands NLM ID: 15030100R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1552-6259 (Electronic) Linking ISSN: 00034975 NLM ISO Abbreviation: Ann Thorac Surg Subsets: MEDLINE
Subject
Language
English
Abstract
Background: The management of aortic stenosis has evolved to stratification by age as reflected in recent societal guidelines. We evaluated age-stratified surgical aortic valve replacement (SAVR) trends and outcomes in patients with bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV) from The Society of Thoracic Surgeons Adult Cardiac Surgery Database.
Methods: This cohort included adults (≥18 years) undergoing SAVR for severe aortic stenosis between July 2011 and December 2022. Comparisons were stratified by age (<65 years, 65-79 years, ≥80 years) and BAV or TAV status. Primary end points included operative mortality, composite morbidity and mortality, and permanent stroke. Observed to expected ratios by The Society of Thoracic Surgeons predicted risk of mortality were calculated.
Results: In total, 200,849 SAVR patients (55,326 BAV [27.5%], 145,526 TAV [72.5%]) from 1238 participating hospitals met study criteria. Annual SAVR volumes decreased by 45% (19,560 to 10,851) during the study period. The decrease was greatest (96%) for patients ≥80 years of age (4914 to 207). The relative prevalence of BAV was greater in younger patients (<65 years, 69,068 [49.5% BAV]; 65-79 years, 104,382 [19.1% BAV]; ≥80 years, 27,399 [4.5% BAV]). The observed mortality in <80-year-old BAV patients (<65 years, 1.08; 65-79 years, 1.21; ≥80 years, 3.68) was better than the expected mortality rate (<65 years, 1.22; 65-79 years, 1.54; ≥80 years, 3.14).
Conclusions: SAVR volume in the transcatheter era has decreased substantially, particularly for patients ≥80 years old and for those with TAV. Younger patients with BAV have better than expected outcomes, which should be carefully considered during shared decision-making in the treatment of aortic stenosis. SAVR should remain the preferred therapy in this population.
(Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Methods: This cohort included adults (≥18 years) undergoing SAVR for severe aortic stenosis between July 2011 and December 2022. Comparisons were stratified by age (<65 years, 65-79 years, ≥80 years) and BAV or TAV status. Primary end points included operative mortality, composite morbidity and mortality, and permanent stroke. Observed to expected ratios by The Society of Thoracic Surgeons predicted risk of mortality were calculated.
Results: In total, 200,849 SAVR patients (55,326 BAV [27.5%], 145,526 TAV [72.5%]) from 1238 participating hospitals met study criteria. Annual SAVR volumes decreased by 45% (19,560 to 10,851) during the study period. The decrease was greatest (96%) for patients ≥80 years of age (4914 to 207). The relative prevalence of BAV was greater in younger patients (<65 years, 69,068 [49.5% BAV]; 65-79 years, 104,382 [19.1% BAV]; ≥80 years, 27,399 [4.5% BAV]). The observed mortality in <80-year-old BAV patients (<65 years, 1.08; 65-79 years, 1.21; ≥80 years, 3.68) was better than the expected mortality rate (<65 years, 1.22; 65-79 years, 1.54; ≥80 years, 3.14).
Conclusions: SAVR volume in the transcatheter era has decreased substantially, particularly for patients ≥80 years old and for those with TAV. Younger patients with BAV have better than expected outcomes, which should be carefully considered during shared decision-making in the treatment of aortic stenosis. SAVR should remain the preferred therapy in this population.
(Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)