Author + information
- Received December 19, 2017
- Revision received January 20, 2018
- Accepted January 22, 2018
- Published online March 26, 2018.
- Tania Rodriguez-Gabella, MD,
- Pierre Voisine, MD,
- François Dagenais, MD,
- Siamak Mohammadi, MD,
- Jean Perron, MD,
- Eric Dumont, MD,
- Rishi Puri, MD, PhD,
- Lluis Asmarats, MD,
- Mélanie Côté, MSc,
- Sebastien Bergeron, MD,
- Philippe Pibarot, PhD and
- Josep Rodés-Cabau, MD∗ ()
- ↵∗Address for correspondence:
Dr. Josep Rodés-Cabau, Quebec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City, Quebec G1V 4G5, Canada.
Background Few data exist on long-term outcomes and structural valve degeneration (SVD) in consecutive unselected patients undergoing surgical aortic valve replacement (SAVR).
Objectives The goal of this study was to determine the long-term outcomes of a contemporary cohort of consecutive unselected SAVR recipients with a focus on evaluating clinical outcomes and SVD based on echocardiographic criteria.
Methods A total of 672 consecutive patients (mean age: 72 ± 8 years; 61.5% male) undergoing SAVR with a bioprosthesis between 2002 and 2004 were included. Baseline and follow-up data were prospectively collected in a dedicated database. Baseline post-operative echocardiographic data were obtained in the 624 patients alive at hospital discharge and in 209 patients at 10 years (87% of the patients at risk). SVD was defined as subclinical (increase >10 mm Hg in mean transvalvular gradient + decrease >0.3 cm2 in valve area and/or new-onset mild or moderate aortic regurgitation) and clinically relevant (increase >20 mm Hg in mean transvalvular gradient + decrease >0.6 cm2 in valve area and/or new-onset moderate-to-severe aortic regurgitation).
Results At a median follow-up of 10 years (interquartile range: 5 to 13 years), 432 patients (64.3%) had died. Older age, left ventricular dysfunction, atrial fibrillation, chronic obstructive pulmonary disease, greater body mass index, and diabetes mellitus were associated with an increased mortality risk (p < 0.05 for all). Clinically relevant SVD occurred in 6.6% of patients; 30.1% of patients had subclinical SVD. A greater body mass index and the use of a specific aortic bioprosthesis were independently associated with clinically relevant SVD (p < 0.05 for both), and 83% of these patients underwent aortic valve reintervention (valve-in-valve transcatheter aortic valve replacement in 44% of them).
Conclusions The 10-year mortality rate in elderly SAVR recipients of a bioprosthetic valve was considerable, chiefly determined by their older age and the presence of comorbidities. Clinically relevant SVD was infrequent, but close to one third of the population exhibited subclinical SVD. These results provide contemporary data on long-term clinical outcomes and SVD post-SAVR, and they should be taken into consideration when evaluating late clinical outcomes and valve durability after transcatheter aortic valve replacement.
Drs. Rodriguez-Gabella and Asmarats were supported by a grant from the Fundacion Alfonso Martin Escudero, Madrid, Spain. Dr. Pibarot has received research contracts with Edwards Lifesciences and Medtronic. Dr. Josep Rodés-Cabau holds the Canadian Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions. All other authors have reported that they have no other relationships relevant to the contents of this paper to disclose. Subodh Verma, MD, served as Guest Editor for this paper.
- Received December 19, 2017.
- Revision received January 20, 2018.
- Accepted January 22, 2018.
- 2018 American College of Cardiology Foundation
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