Outcomes of Surgical Aortic Valve Replacement in Patients Discussed in the Trans-Catheter Aortic Valve Replacement Heart Team

Reut Shavit Department of Cardiothoracic Surgery, Rabin Medical Center, Petach Tikva, Israel Yaron Shapira Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel Alexander Sagie Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel Abed Assali Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel Hana Vaknin-Assa Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel Katia Orvin Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel Ashraf Hamdan Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel Pablo Codner Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel Uri Landes Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel Amos Levi Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel Yoav Hammer Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel Eitan Snir Department of Cardiothoracic Surgery, Rabin Medical Center, Petach Tikva, Israel Dan Aravot Department of Cardiothoracic Surgery, Rabin Medical Center, Petach Tikva, Israel Ran Kornowski Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel Ram Sharony Department of Cardiothoracic Surgery, Rabin Medical Center, Petach Tikva, Israel

Background:

Trans-catheter aortic valve replacement (TAVR) has evolved as an alternative for surgical aortic valve replacement (SAVR) in high and intermediate risk patients with aortic stenosis. Heart Team discussion has a prominent role in the decision making process for either therapy.

We sought to analyze the clinical results of TAVR candidates who were eventually selected for SAVR.

Methods:

Between 2014-2017, TAVR candidates who underwent SAVR were analyzed. All of these patients were discussed in heart team forum, and personally examined by the surgeon. Demographic data, pre-operative risk, as well as intraoperative and postoperative short and intermediate term clinical and echocardiographic results were recorded.

Results:

SAVR was performed in 32 patients (mean age 75±6.08, 25% octogenarians, 59% males). The mean preoperative FC and STS scores were 2.51±0.45 and 3±0.03%, respectively. Isolated AVR was performed in 19 patients (59%). Of them, 7 (36%) underwent minimally invasive approaches. Combined procedures included CABG (n=10, 31%) and others (n=3, 9%). Three (9%) were re-operations. Stented bioprosthetic valves were implanted in 22 patients (69%) and rapidly deployed sutureless valves in 10 (31%). No operative mortality was documented. Post-operative mean gradient was 8.9±2.8 mmHg. None had even mild paravalvular leak. There were no disabling strokes. Three (9%) permanent pacemakers were implanted (two due to complete AV block ,6%). No deep wound infections were recorded. Median hospitalization length was 7.5 days. Survival rate during follow-up (mean of 18±13.5 months) was 100%.

Conclusions:

Surgical aortic valve replacement for patients considered at an increased operative risk, thoroughly discussed in heart team meetings, is associated with good surgical results and low complications rate. With the advent of new generation aortic valves and less invasive approach, SAVR remains a safe and effective treatment. Heart team discussions must consider the individualized risk-benefit, swinging the pendulum for the best solution for these patients.

Reut Shavit

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