Long-term outcomes of conventional aortic valve replacement in high-risk patients: Where do we stand?

Purpose: The introduction of transcatheter aortic valves has focused attention on the results of conventional aortic valve surgery in high-risk patients. The aim of the study was to evaluate 5-years outcomes in this category of patients in the current surgical era. Methods: This is an observational retrospective study of 581 high-risk patients undergoing aortic valve replacement from 2008 to 2013,with a mean logistic EuroSCORE of 26.6% ± 14.6%. Data were prospectively collected in a database of Emilia-Romagna region (Italy). Results: Overall 30-day mortality was 9.3%. Stroke rate was 1.5%. At 1-,3-,and 5-years overall mortality was 18.2%,30.4%,and 42.2%,cardiac death rate was 3.9%,9.2%,and 12.9%,stroke rate 2.5%,7.7%,and 10.2%,re-operation occurrence 0.2%,0.9% and 1.3%,and new pacemaker implantation was 2.3%,5.1% and 7.8%. At multivariate analysis,urgency,hemodynamic instability,LVEF ≤30%,NYHA III-IV,severe chronic obstructive pulmonary disease (COPD),extra-cardiac arteriopathy,cerebrovascular disease,and creatinine >2.0 mg/dL remained independent predictors of 5-year mortality. Conclusion: The results of the current study add weight to the evidence that traditional aortic valve replacement can be performed in high-risk patients with satisfactory 5-year mortality and morbidity. Our study may help to improve decision-making in this category of high-risk patients with aortic valve disease. © 2016 The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery. All rights reserved.