1
|
Norton EL, Ward AF, Tully A, Leshnower BG, Guyton RA, Paone G, Keeling WB, Miller JS, Halkos ME, Grubb KJ. Trends in surgical aortic valve replacement in pre- and post-transcatheter aortic valve replacement eras at a structural heart center. Front Cardiovasc Med 2023; 10:1103760. [PMID: 37283574 PMCID: PMC10239805 DOI: 10.3389/fcvm.2023.1103760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/03/2023] [Indexed: 06/08/2023] Open
Abstract
Background The advent of transcatheter aortic valve replacement (TAVR) has directly impacted the lifelong management of patients with aortic valve disease. The U.S. Food and Drug Administration has approved TAVR for all surgical risk: prohibitive (2011), high (2012), intermediate (2016), and low (2019). Since then, TAVR volumes are increasing and surgical aortic valve replacements (SAVR) are decreasing. This study sought to evaluate trends in isolated SAVR in the pre- and post-TAVR eras. Methods From January 2000 to June 2020, 3,861 isolated SAVRs were performed at a single academic quaternary care institution which participated in the early trials of TAVR beginning in 2007. A formal structural heart center was established in 2012 when TAVR became commercially available. Patients were divided into the pre-TAVR era (2000-2011, n = 2,426) and post-TAVR era (2012-2020, n = 1,435). Data from the institutional Society of Thoracic Surgeons National Database was analyzed. Results The median age was 66 years, similar between groups. The post-TAVR group had a statistically higher rate of diabetes, hypertension, dyslipidemia, heart failure, more reoperative SAVR, and lower STS Predicted Risk of Mortality (PROM) (2.0% vs. 2.5%, p < 0.0001). There were more urgent/emergent/salvage SAVRs (38% vs. 24%) and fewer elective SAVRs (63% vs. 76%), (p < 0.0001) in the post-TAVR group. More bioprosthetic valves were implanted in the post-TAVR group (85% vs. 74%, p < 0.0001). Larger aortic valves were implanted (25 vs. 23 mm, p < 0.0001) and more annular enlargements were performed (5.9% vs. 1.6%, p < 0.0001) in the post-TAVR era. Postoperatively, the post-TAVR group had less blood product transfusion (49% vs. 58%, p < 0.0001), renal failure (1.4% vs. 4.3%, p < 0.0001), pneumonia (2.3% vs. 3.8%, p = 0.01), shorter lengths of stay, and lower in-hospital mortality (1.5% vs. 3.3%, p = 0.0007). Conclusion The approval of TAVR changed the landscape of aortic valve disease management. At a quaternary academic cardiac surgery center with a well-established structural heart program, patients undergoing isolated SAVR in the post-TAVR era had lower STS PROM, more implantation of bioprosthetic valves, utilization of larger valves, annular enlargement, and lower in-hospital mortality. Isolated SAVR continues to be performed in the TAVR era with excellent outcomes. SAVR remains an essential tool in the lifetime management of aortic valve disease.
Collapse
Affiliation(s)
- Elizabeth L. Norton
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
| | - Alison F. Ward
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
| | - Andy Tully
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
- Structural Heart and Valve Center, Emory University, Atlanta, GA, United States
| | - Bradley G. Leshnower
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
- Structural Heart and Valve Center, Emory University, Atlanta, GA, United States
| | - Robert A. Guyton
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
- Structural Heart and Valve Center, Emory University, Atlanta, GA, United States
| | - Gaetano Paone
- Structural Heart and Valve Center, Emory University, Atlanta, GA, United States
| | - William B. Keeling
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
- Structural Heart and Valve Center, Emory University, Atlanta, GA, United States
| | - Jeffrey S. Miller
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
- Structural Heart and Valve Center, Emory University, Atlanta, GA, United States
| | - Michael E. Halkos
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
- Structural Heart and Valve Center, Emory University, Atlanta, GA, United States
| | - Kendra J. Grubb
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
- Structural Heart and Valve Center, Emory University, Atlanta, GA, United States
| |
Collapse
|
2
|
El Nihum LI, Al Abri Q, Telmesani A, Ali A, He YA, Hinohara T, Reyes M, Ramchandani M, Reardon MJ. Surgical Salvage of Annular Rupture After Transcatheter Aortic Valve Implantation by Conversion Into Annular Enlargement. JACC Case Rep 2022; 4:1529-1533. [PMID: 36444183 PMCID: PMC9700071 DOI: 10.1016/j.jaccas.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/20/2022] [Accepted: 08/04/2022] [Indexed: 06/16/2023]
Abstract
We describe an 88-year-old woman who experienced annular rupture during transcatheter aortic valve replacement despite preventative measures. She underwent Y incision and rectangular patch for the double purpose of repairing the rupture and enlarging the aortic root. We highlight the heart team's role in confronting this potentially catastrophic complication. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Lamees I. El Nihum
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
- Texas A&M College of Medicine, Bryan, Texas, USA
| | - Qasim Al Abri
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Amr Telmesani
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Areeba Ali
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Yuncen A. He
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Tomoya Hinohara
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Manuel Reyes
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Mahesh Ramchandani
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Michael J. Reardon
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| |
Collapse
|
3
|
Yousef S, Sultan I. Aortic root enlargement: Just do it. J Card Surg 2022; 37:2395-2396. [PMID: 35643854 DOI: 10.1111/jocs.16638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/27/2022]
Abstract
Aortic root enlargement (ARE) can be an important adjunct for aortic valve replacement (AVR) in patients with small annuli, but incremental morbidity of this procedure is not well understood.
Collapse
Affiliation(s)
- Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|