TY - JOUR
T1 - Aortic Valve Replacement in Bioprosthetic Failure
T2 - Insights From The Society of Thoracic Surgeons National Database
AU - Kalra, Ankur
AU - Raza, Sajjad
AU - Hussain, Mehwish
AU - Shorbaji, Khaled
AU - Delozier, Sarah
AU - Deo, Salil V.
AU - Khera, Sahil
AU - Kleiman, Neal S.
AU - Reardon, Michael J.
AU - Kolte, Dhaval
AU - Gupta, Tanush
AU - Mustafa, Rami
AU - Bhatt, Deepak L.
AU - Sabik, Joseph F.
N1 - Funding Information:
Dr Joseph F. Sabik discloses a relationship as the North American principal investigator for the Abbott Laboratories–sponsored left main coronary disease randomized trial (EXCEL), The Society of Thoracic Surgeons Board of Directors, the Medtronic Scientific Advisory Board, and principal investigator for The PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Pivotal Trial that evaluates the safety and effectiveness of the Avalus aortic valve bioprosthesis. Dr Deepak L. Bhatt: advisory board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; board of directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; data monitoring committee: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute) for the PORTICO trial, funded by St. Jude Medical (now Abbott), Cleveland Clinic, Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), Population Health Research Institute; honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute); RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim, Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); research funding: Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines Company; royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); site coinvestigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott), Svelte; trustee: American College of Cardiology; and unfunded research: FlowCo, Merck, Novo Nordisk, PLx Pharma, and Takeda.
Publisher Copyright:
© 2020 The Society of Thoracic Surgeons
PY - 2020/11
Y1 - 2020/11
N2 - Background: This study was conducted to determine the current nationwide trends and outcomes of reoperative surgical aortic valve replacement (SAVR) performed for a degenerated bioprosthesis. Methods: Data from The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were used. All patients who underwent isolated reoperative SAVR for a degenerated aortic bioprosthesis between January 2012 and December 2016 were included. Patients who had other concomitant cardiac surgery procedures or active endocarditis were excluded. Changes during this period were tracked with trend analyses. Results: The number of patients undergoing SAVR for bioprosthetic failure increased substantially between 2012 and 2014 (782 in 2012 to 844 in 2013 and to 900 in 2014; relative change, +7.25%); this trend reversed significantly between 2015 and 2016 (decreased to 873 in 2015 and to 840 in 2016; relative change, −3.4%; P = .005). Patients were older in 2012-2014 (65.80 ± 13.52 years) compared with 2015-2016 (64.45 ± 12.91 years; P = .001). Mean STS-predicted mortality risk score decreased from 4.55% in 2012-2014 to 4.25% in 2015-2016 (P = .001). There was no difference in postoperative stroke (1.80% vs 1.80%, P = .87), renal failure requiring dialysis (2.7% vs 2.8%, P = .69), or operative mortality (3.5% vs 4.0%, P = .36) after reoperative SAVR in 2012-2014 and 2015-2016, respectively. Conclusions: The number of patients undergoing SAVR for a degenerated bioprosthesis is decreasing in the United States, particularly among older and high-risk patients. These trends may reflect the adoption of valve-in-valve transcatheter aortic valve replacement for a degenerated bioprosthesis after its United States Food and Drug Administration approval in 2015.
AB - Background: This study was conducted to determine the current nationwide trends and outcomes of reoperative surgical aortic valve replacement (SAVR) performed for a degenerated bioprosthesis. Methods: Data from The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were used. All patients who underwent isolated reoperative SAVR for a degenerated aortic bioprosthesis between January 2012 and December 2016 were included. Patients who had other concomitant cardiac surgery procedures or active endocarditis were excluded. Changes during this period were tracked with trend analyses. Results: The number of patients undergoing SAVR for bioprosthetic failure increased substantially between 2012 and 2014 (782 in 2012 to 844 in 2013 and to 900 in 2014; relative change, +7.25%); this trend reversed significantly between 2015 and 2016 (decreased to 873 in 2015 and to 840 in 2016; relative change, −3.4%; P = .005). Patients were older in 2012-2014 (65.80 ± 13.52 years) compared with 2015-2016 (64.45 ± 12.91 years; P = .001). Mean STS-predicted mortality risk score decreased from 4.55% in 2012-2014 to 4.25% in 2015-2016 (P = .001). There was no difference in postoperative stroke (1.80% vs 1.80%, P = .87), renal failure requiring dialysis (2.7% vs 2.8%, P = .69), or operative mortality (3.5% vs 4.0%, P = .36) after reoperative SAVR in 2012-2014 and 2015-2016, respectively. Conclusions: The number of patients undergoing SAVR for a degenerated bioprosthesis is decreasing in the United States, particularly among older and high-risk patients. These trends may reflect the adoption of valve-in-valve transcatheter aortic valve replacement for a degenerated bioprosthesis after its United States Food and Drug Administration approval in 2015.
UR - http://www.scopus.com/inward/record.url?scp=85093656984&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2019.08.023
DO - 10.1016/j.athoracsur.2019.08.023
M3 - Article
C2 - 31557477
AN - SCOPUS:85093656984
SN - 0003-4975
VL - 110
SP - 1637
EP - 1642
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -