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- Title
The Outcomes for Different Biological Heart Valve Prostheses in Surgical Aortic Valve Replacement before and after the Introduction of Transcatheter Aortic Valve Implantation.
- Authors
Deblier, Ivo; Dossche, Karl; Vanermen, Anthony; Mistiaen, Wilhelm
- Abstract
Surgical aortic valve replacement (SAVR) was the only symptom relieving and life-prolonging treatment until transcatheter aortic valve implantation (TAVI) became available. This option was introduced to treat old and high-risk patients. In a series of 2500 consecutive patients referred for SAVR with a biologic heart valve (BHV) prosthesis, their age, comorbid conditions, the complexity of the procedure, postoperative outcome, need for resources, and long-term survival were compared in patients before versus after the introduction of TAVI. Although the Carpentier-Edwards valve was used in most patients, the outcomes with respect to several other BHV types were studied. Patients undergoing isolated SAVR (i-SAVR) were studied separately from those who underwent SAVR with a concomitant procedure (c-SAVR). The number of referrals increased over time until 2016, whereafter the reimbursement for TAVI broadened. Age, prior percutaneous coronary interventions, diabetes, and chronic renal disease increased over time in both groups, while atrial fibrillation, the need for emergent SAVR, and other comorbid conditions increased significantly only in the c-SAVR group. Postoperative acute renal injury, conduction defects, and bleeding increased over time in both groups. The need for renal replacement therapy increased in both surgical groups, but this was more pronounced in c-SAVR; the need for a pacemaker implant (p < 0.001), blood products, and reintervention increased only in the c-SAVR group. There was a moderate but non-significant increase in the 30-day mortality for both groups over time. Furthermore, the long-term survival of both groups did not change after the introduction of TAVI. The Carpentier-Edwards Perimount valve showed good long-term results for durability. The Perceval device was used in older patients and showed good hemodynamic results, but the need for a postoperative permanent pacemaker implant was high. The results seem to indicate that a broader reimbursement for TAVI was warranted after its introduction in 2008. Nevertheless, with the development of newer devices for SAVR, surgery will remain one of the major treatment options for aortic valve disease.
- Subjects
DIABETES risk factors; HEMORRHAGE risk factors; HYPERTENSION risk factors; MORTALITY risk factors; THROMBOEMBOLISM risk factors; MEDICAL care use; PERIPHERAL vascular diseases; PROSTHETIC heart valves; TREATMENT effectiveness; AGE distribution; RETROSPECTIVE studies; PREOPERATIVE care; ENDOCARDITIS; HEART valve prosthesis implantation; SURGICAL complications; CHRONIC kidney failure; BIOPROSTHETIC heart valves; AORTIC stenosis; ATRIAL fibrillation; PERCUTANEOUS coronary intervention; MEDICAL records; ACQUISITION of data; STROKE; ADVERSE health care events; NEEDS assessment; MEDICAL referrals; COMORBIDITY; ECHOCARDIOGRAPHY; DISEASE risk factors
- Publication
Prosthesis (2673-1592), 2024, Vol 6, Issue 3, p708
- ISSN
2673-1592
- Publication type
Article
- DOI
10.3390/prosthesis6030050