Outcome of conventional aortic valve replacement in the era of transcatheter aortic valve implantation

Objectives: Conventional aortic valve replacement (AVR) is a standard procedure with low morbidities and mortalities. Aim of this study was to analyze the outcome of conventional AVR in all comers when high-risk patients were treated using transcatheter aortic valve implantation (T-AVI) in parallel.

Methods: All patients receiving elective isolated AVR in the year 2010 were included into this study. Perioperative data were prospectively collected and retrospectively analyzed.

Results: In the year 2010 a total of 212 patients underwent elective isolated conventional AVR at our institution. Mean age was 69±10 years and 48% were female. Logistic EuroSCORE was 6.8±5.9% and 67.0% of the patients were in NYHA functional class 3 or 4. Minimally invasive approach through an upper partial sternotomy was used in 30.7% of the patients. Median procedure time was 150 minutes (interquartile range 133–178 minutes) with a median cross-clamp time of 56 minutes (interquartile range 47–66 minutes). 30-day mortality was 0.94% (n=2). The incidence of new stroke and postoperative need for renal replacement therapy was 0.94% each and the incidence of new pacemaker implantations was 3.8%. Median intensive care unit stay was 1 day (interquartile range 1–2 days) and median length of hospital stay was 10 days (interquartile range 8–12 days). Incidence of postoperative aortic regurgitation grade 1 was 7.1% and grade 2 0.5% (n=1), rspectively. Subgroup analysis revealed similar outcomes between patients treated with minimally invasive versus conventional full sternotomy access.

Conclusions: Conventional AVR is associated with excellent outcomes and should remain the golden-standard for the treatment of patients with severe aortic valve stenosis at low and moderate surgical risk. Conventional AVR can be performed with very low risk using a conventional full sternotomy or a minimally invasive partial sternotomy approach.