Aortic Valve Replacement in Intermediate Risk Patients: Surgical Outcomes

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Abstract

Background: Conventional surgery still represents the gold standard therapeutic strategy for aortic valve disease with adequate
outcomes according to the operative risk. The use of transcatheter aortic valve implantation (TAVI) for the treatment of aortic
stenosis (AS) has dramatically increased and is being considered for intermediate risk (IR) patients. As the information about the
outcomes of surgical aortic valve replacement (AVR) in this particular group of patients is uncommon in our setting, we present the
results in our “real world”.
Objectives: The aim of the study was to report the rate of early complications in patients undergoing AVR with IR for mortality
(STS PROM% 4%-8%).
Methods: A retrospective analysis of patients undergoing surgical AVR was conducted between January 2007 and March 2017. A
total of 877 isolated AVR procedures or associated with coronary artery bypass graft surgery (CABGS) were performed. Patients
with severe AS, severe aortic regurgitation, endocarditis and STS PROM 4%-8% were included in the study. Patients at low or high
surgical risk (STS PROM < 4% or >8%), with double valve surgery or associated procedures (except for CABGS or aortic annular
enlargement) were excluded.
Results: A total of 97 patients were included in the study. Mean age was 79.4±6.18 years, and 60.82% were men. Median STS PROM
was 5.1% (4.4-6) and 62.9% of patients underwent CABGS. No cases of moderate or severe paravalvular leak were reported. Thirtyday
mortality was 5.1%. The following complications were reported: ischemic stroke (3.1%), definite pacemaker requirement (4.1%)
and reoperation due to bleeding (4.1%). Total hospital stay was 8 days (6-14).
Conclusions: The results in IR patients were consistent with those expected in terms of postoperative morbidity and mortality.