Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database

Marjan Jahangiri; Rajdeep Bilkhu; Andrew Embleton-Thirsk; Hakim-Moulay Dehbi; Krishna Mani; Jon Anderson; Vassilios Avlonitis; Max Baghai; Inderpaul Birdi; Karen Booth; Amal Bose; Norman Briffa; Keith Buchan; Sunil Bhudia; Alex Cale; Indu Deglurkar; Shakil Farid; Leonidas Hadjinikolaou; Martin Jarvis; Seyed Hossein Javadpour; Reubendra Jeganathan; Manoj Kuduvalli; Kulvinder Lall; Jorge Mascaro; Dheeraj Mehta; Sunil Ohri; Prakash Punjabi; Rajamiyer Venkateswaran; Paul Ridley; Christopher Satur; Serban Stoica; Uday Trivedi; Afzal Zaidi; Patrick Yiu; Narain Moorjani; Simon Kendall; Nick Freemantle

doi:10.1136/bmjopen-2020-046491

Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database

Marjan Jahangiri^*, Rajdeep Bilkhu, Andrew Embleton-Thirsk, Hakim-Moulay Dehbi, Krishna Mani, Jon Anderson, Vassilios Avlonitis, Max Baghai, Inderpaul Birdi, Karen Booth, Amal Bose, Norman Briffa, Keith Buchan, Sunil Bhudia, Alex Cale, Indu Deglurkar, Shakil Farid, Leonidas Hadjinikolaou, Martin Jarvis, Seyed Hossein JavadpourReubendra Jeganathan, Manoj Kuduvalli, Kulvinder Lall, Jorge Mascaro, Dheeraj Mehta, Sunil Ohri, Prakash Punjabi, Rajamiyer Venkateswaran, Paul Ridley, Christopher Satur, Serban Stoica, Uday Trivedi, Afzal Zaidi, Patrick Yiu, Narain Moorjani, Simon Kendall, Nick Freemantle

^*Corresponding author for this work

Bristol Medical School (THS)

Research output: Contribution to journal › Review article (Academic Journal) › peer-review

16 Citations (Scopus)

Abstract

Objectives

To date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore ‘real-world’ practice.

Design Retrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants’ demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed.

Setting

27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis.

Participants

31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG.

Results

In-hospital mortality for isolated SAVR was 1.9% (95% CI 1.6% to 2.1%) and was 2.4% for AVR+CABG. Mortality by age category for SAVR only were: <60 years=2.0%, 60–75 years=1.5%, >75 years=2.2%. For SAVR+CABG these were; 2.2%, 1.8% and 3.1%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3%, in intermediate risk 1% and for high risk 3.9%. 74.3% of the operations were elective, 24% urgent and 1.7% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9% and 1.1%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes.

Conclusions

Surgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease.

Original language	English
Article number	e046491
Number of pages	10
Journal	BMJ Open
Volume	11
Issue number	10
DOIs	https://doi.org/10.1136/bmjopen-2020-046491
Publication status	Published - 28 Oct 2021

Bibliographical note

Publisher Copyrigt:
© Author(s) (or their employer(s)) 2021.

Keywords

Aortic Valve/surgery
Aortic Valve Stenosis/surgery
Heart Valve Prosthesis Implantation
Humans
Middle Aged
Postoperative Complications/epidemiology
Retrospective Studies
Risk Assessment
Risk Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome
United Kingdom/epidemiology

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Jahangiri, M., Bilkhu, R., Embleton-Thirsk, A., Dehbi, H.-M., Mani, K., Anderson, J., Avlonitis, V., Baghai, M., Birdi, I., Booth, K., Bose, A., Briffa, N., Buchan, K., Bhudia, S., Cale, A., Deglurkar, I., Farid, S., Hadjinikolaou, L., Jarvis, M., ... Freemantle, N. (2021). Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database. BMJ Open, 11(10), Article e046491. https://doi.org/10.1136/bmjopen-2020-046491

@article{2211bf8da4a14a0a88e543e3b7ae4895,

title = "Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database",

abstract = "Objectives To date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore {\textquoteleft}real-world{\textquoteright} practice.Design Retrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants{\textquoteright} demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed. Setting 27 (90\%) tertiary cardiac surgical centres in the UK submitted their data for analysis. Participants 31 277 people with AVR were identified. 19 670 (62.9\%) had only SAVR and 11 607 (37.1\%) had AVR+CABG. Results In-hospital mortality for isolated SAVR was 1.9\% (95\% CI 1.6\% to 2.1\%) and was 2.4\% for AVR+CABG. Mortality by age category for SAVR only were: <60 years=2.0\%, 60–75 years=1.5\%, >75 years=2.2\%. For SAVR+CABG these were; 2.2\%, 1.8\% and 3.1\%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3\%, in intermediate risk 1\% and for high risk 3.9\%. 74.3\% of the operations were elective, 24\% urgent and 1.7\% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9\% and 1.1\%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes. Conclusions Surgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease.",

keywords = "Aortic Valve/surgery, Aortic Valve Stenosis/surgery, Heart Valve Prosthesis Implantation, Humans, Middle Aged, Postoperative Complications/epidemiology, Retrospective Studies, Risk Assessment, Risk Factors, Transcatheter Aortic Valve Replacement, Treatment Outcome, United Kingdom/epidemiology",

author = "Marjan Jahangiri and Rajdeep Bilkhu and Andrew Embleton-Thirsk and Hakim-Moulay Dehbi and Krishna Mani and Jon Anderson and Vassilios Avlonitis and Max Baghai and Inderpaul Birdi and Karen Booth and Amal Bose and Norman Briffa and Keith Buchan and Sunil Bhudia and Alex Cale and Indu Deglurkar and Shakil Farid and Leonidas Hadjinikolaou and Martin Jarvis and Javadpour, \{Seyed Hossein\} and Reubendra Jeganathan and Manoj Kuduvalli and Kulvinder Lall and Jorge Mascaro and Dheeraj Mehta and Sunil Ohri and Prakash Punjabi and Rajamiyer Venkateswaran and Paul Ridley and Christopher Satur and Serban Stoica and Uday Trivedi and Afzal Zaidi and Patrick Yiu and Narain Moorjani and Simon Kendall and Nick Freemantle",

note = "Publisher Copyrigt: {\textcopyright} Author(s) (or their employer(s)) 2021.",

year = "2021",

month = oct,

day = "28",

doi = "10.1136/bmjopen-2020-046491",

language = "English",

volume = "11",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "10",

}

Jahangiri, M, Bilkhu, R, Embleton-Thirsk, A, Dehbi, H-M, Mani, K, Anderson, J, Avlonitis, V, Baghai, M, Birdi, I, Booth, K, Bose, A, Briffa, N, Buchan, K, Bhudia, S, Cale, A, Deglurkar, I, Farid, S, Hadjinikolaou, L, Jarvis, M, Javadpour, SH, Jeganathan, R, Kuduvalli, M, Lall, K, Mascaro, J, Mehta, D, Ohri, S, Punjabi, P, Venkateswaran, R, Ridley, P, Satur, C, Stoica, S, Trivedi, U, Zaidi, A, Yiu, P, Moorjani, N, Kendall, S & Freemantle, N 2021, 'Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database', BMJ Open, vol. 11, no. 10, e046491. https://doi.org/10.1136/bmjopen-2020-046491

TY - JOUR

T1 - Surgical aortic valve replacement in the era of transcatheter aortic valve implantation

T2 - a review of the UK national database

AU - Jahangiri, Marjan

AU - Bilkhu, Rajdeep

AU - Embleton-Thirsk, Andrew

AU - Dehbi, Hakim-Moulay

AU - Mani, Krishna

AU - Anderson, Jon

AU - Avlonitis, Vassilios

AU - Baghai, Max

AU - Birdi, Inderpaul

AU - Booth, Karen

AU - Bose, Amal

AU - Briffa, Norman

AU - Buchan, Keith

AU - Bhudia, Sunil

AU - Cale, Alex

AU - Deglurkar, Indu

AU - Farid, Shakil

AU - Hadjinikolaou, Leonidas

AU - Jarvis, Martin

AU - Javadpour, Seyed Hossein

AU - Jeganathan, Reubendra

AU - Kuduvalli, Manoj

AU - Lall, Kulvinder

AU - Mascaro, Jorge

AU - Mehta, Dheeraj

AU - Ohri, Sunil

AU - Punjabi, Prakash

AU - Venkateswaran, Rajamiyer

AU - Ridley, Paul

AU - Satur, Christopher

AU - Stoica, Serban

AU - Trivedi, Uday

AU - Zaidi, Afzal

AU - Yiu, Patrick

AU - Moorjani, Narain

AU - Kendall, Simon

AU - Freemantle, Nick

PY - 2021/10/28

Y1 - 2021/10/28

N2 - Objectives To date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore ‘real-world’ practice.Design Retrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants’ demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed. Setting 27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis. Participants 31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG. Results In-hospital mortality for isolated SAVR was 1.9% (95% CI 1.6% to 2.1%) and was 2.4% for AVR+CABG. Mortality by age category for SAVR only were: <60 years=2.0%, 60–75 years=1.5%, >75 years=2.2%. For SAVR+CABG these were; 2.2%, 1.8% and 3.1%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3%, in intermediate risk 1% and for high risk 3.9%. 74.3% of the operations were elective, 24% urgent and 1.7% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9% and 1.1%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes. Conclusions Surgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease.

AB - Objectives To date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore ‘real-world’ practice.Design Retrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants’ demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed. Setting 27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis. Participants 31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG. Results In-hospital mortality for isolated SAVR was 1.9% (95% CI 1.6% to 2.1%) and was 2.4% for AVR+CABG. Mortality by age category for SAVR only were: <60 years=2.0%, 60–75 years=1.5%, >75 years=2.2%. For SAVR+CABG these were; 2.2%, 1.8% and 3.1%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3%, in intermediate risk 1% and for high risk 3.9%. 74.3% of the operations were elective, 24% urgent and 1.7% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9% and 1.1%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes. Conclusions Surgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease.

KW - Aortic Valve/surgery

KW - Aortic Valve Stenosis/surgery

KW - Heart Valve Prosthesis Implantation

KW - Humans

KW - Middle Aged

KW - Postoperative Complications/epidemiology

KW - Retrospective Studies

KW - Risk Assessment

KW - Risk Factors

KW - Transcatheter Aortic Valve Replacement

KW - Treatment Outcome

KW - United Kingdom/epidemiology

U2 - 10.1136/bmjopen-2020-046491

DO - 10.1136/bmjopen-2020-046491

M3 - Review article (Academic Journal)

C2 - 34711589

SN - 2044-6055

VL - 11

JO - BMJ Open

JF - BMJ Open

IS - 10

M1 - e046491

ER -

Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database

Abstract

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