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Conventional aortic valve replacement for high-risk aortic stenosis patients not suitable for trans-catheter aortic valve implantation: feasibility and outcome☆

2011; Oxford University Press; Linguagem: Inglês

10.1016/j.ejcts.2010.12.036

1873-734X

Ioannis Dimarakis, Syed M. Rehman, Stuart W Grant, Duraisamy Saravanan, Richard Lévy, Ben Bridgewater, Isaac Kadir,

Coronary Interventions and Diagnostics

Objective: High-risk patients with aortic stenosis are increasingly referred to specialist multidisciplinary teams (MDTs) for consideration of trans-catheter aortic valve implantation (TAVI). A subgroup of these cases is unsuitable for TAVI, and high-risk conventional aortic valve replacement (AVR) is undertaken. We have studied our outcomes in this cohort. Methods: Data prospectively collected between March 2008 and November 2009 for patients (n = 28, nine male) undergoing high-risk AVR were analysed. The mean age was 78.4 ± 9.2 years. The mean additive EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 10.0 ± 3.6 and mean logistic EuroSCORE was 19.9 ± 18.8. Three patients had undergone previous coronary artery bypass grafting (CABG). Results: The mean ejection fraction was 51 ± 16%, mean valve area 0.56 ± 0.19 cm2, and mean peak gradient 91 ± 27 mmHg. Ascending aortic, right axillary artery and femoral artery cannulation was used in 64%, 29% and 7% of cases, respectively. Median cross-clamp and cardiopulmonary bypass times were 84 (68–143) min and 111 (94–223) min. The median (range) inserted valve size was 21 (19–25) mm. Median intensive care and overall hospital stay were 5 (2–37) and 11 (5–44) days, respectively. In-hospital mortality was 4% (one patient). Postoperative complications included re-operation for bleeding (7%), renal failure (21%), tracheostomy (14%), sternal wound infection (7%), atrial fibrillation (25%) and permanent pacemaker implantation (7%). Kaplan–Meier survival at median follow-up of 359 (148–744) days was 81% (one further death of non-cardiac aetiology). Quality-of-life assessment at follow-up also yielded satisfactory results. Conclusions: MDT assessment of high-risk aortic stenosis in the era of TAVI has increased the number of referrals. Conventional open surgery remains a valid option for these patients, with acceptable in-hospital mortality and early/midterm outcomes but high in-hospital morbidity.