Outcomes of Isolated Surgical Aortic Valve Replacement in Low Risk Patients Aged Above 60 Years Old in the Era of Transcatheter Aortic Valve Implantation

Background: Until the early 21st century, the only therapeutic option for aortic valve stenosis was surgical aortic valve replacement (AVR), but this has changed with the introduction of transcatheter aortic valve implantation (TAVI). The aim of this study was to present the results of surgical AVR in low risk patients, above the age of 60 years, in the era of TAVI in a large tertiary medical center.

Methods: All data from patients aged >60 who had undergone isolated AVR surgery between 2004 and 2018 were obtained from our departmental database. We included all patients who were at low surgical risk defined as Euroscore ≤5. The study population included 314 patients, of them 110 (35%) in the early era (before 2010) and 204 (65%) in the late era (2010 and thereafter). In-hospital, 1-, 3- and 5-year mortality outcome variables were evaluated. Mean follow-up was 70±43 months.

Results: Mean age was 67±5 years, 182 (58%) were male and the mean ejection fraction was 59±8%. 56 patients (18%) had a unicuspid or bicuspid aortic valve. Patient characteristics were similar between the early and late periods. There was no in-hospital or 30-day mortality throughout the entire cohort, with one case (0.3%) of post-operative stroke. Permanent pacemaker implantation was required in 2.2% (N=7). Patients in the early era required significantly more re-exploration due to bleeding/tamponade (8.2% vs. 1.5%, p=0.008). Long-term mortality (1, 3 and 5 years) was higher in the early compared with the late period (2.7% vs. 1%, 7.3% vs. 3% and 15.5% vs. 3.4%, respectively; log-rank p=0.005) (Figure).

Conclusions: Surgical AVR provides excellent short- and long-term results with low morbidity and mortality in low surgical risk patients. While patient characteristics did not change dramatically over the years, the long-term results were encouraging.