Contemporary Conventional Aortic Valve Replacement in All-comer Patients is Associated with Excellent Results

Objectives: In the era of transcatheter aortic valve implantation we thought to analyze the outcome of conventional AVR in an all-comers population.

Methods: Routine quality control data of all patients who underwent isolated AVR between January 2014 and August 2015 as elective or emergent procedures were evaluated.

Results: A total of 405 patients, mean age 69 ± 11 years with 47% female were treated. Logistic EuroSCORE, EuroSCORE II and STS-score were 6.9 ± 5.8%, 2.1 ± 1.2% and 2.0 ± 0.7%, respectively. The majority of patients (63%) were in NYHA functional class 3 or 4. A minimally invasive upper hemisternotomy approach was used in 33.7% of the patients and 32% of the patients received additional epicardial ablation therapy. Median procedure time was 152 minutes (interquartile range 130 - 190 minutes) with a median cross-clamp time of 55 minutes (interquartile range 46 - 69 minutes). 30-day mortality was 0.5% (n = 2). The incidence of new stroke and postoperative need for renal replacement therapy was 0.99% each and the incidence of new pacemaker implantations was 3.7%. 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). Mean transaortic gradients improved from baseline 43.2 ± 20 mm Hg to 13.2 ± 4 mm Hg at discharge (p< 0.001).

Conclusion: Clinical outcome of contemporary conventional AVR in all comer patients with severe aortic valve stenosis at low and intermediate surgical risk is excellent.