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DOI: 10.1055/s-0029-1191462
Isolated aortic valve replacement in high risk patients
Objectives: In this retrospective study we evaluated early and long-term outcome following isolated aortic valve replacement (AVR) in patients with high risk preoperative profile. Nowadays, these patients are under evaluation for catheter-based aortic valve replacement techniques.
Methods: Between 2000 and 2007, 641 patients underwent isolated AVR in our department. Out of this cohort, 110 patients (72 female, mean age: 77.5±7.3 years) had symptomatic aortic stenosis with a calculated EuroSCORE ≥9, representing the study group of patients considered to be potential candidates for catheter-based AVR. Mean aortic valve area was 0.61±0.17cm2. AVR as a redo procedure was necessary in 12 patients (10.9%). Additional intraoperative procedures were annular patch enlargement or septal myectomy (13%, 14 patients).
Results: Hospital mortality was 5.4% (6/110 patients) in this patient cohort with a logistic EuroSCORE predicted mortality risk of 22.3±9%. Pacemaker implantation was necessary in 9 patients (8.1%), and 2 patients (1.8%) sustained a neurological event. Echocardiography assessment revealed excellent hemodynamic function of the prostheses with a mean aortic gradient of 12.3±9.5mmHg at discharge. Follow up was 97% (mean 3.6±2.2 years). Actuarial survival at 1, 3 and 5 years was 88.7%, 78% and 64%, respectively.
Conclusion: Current early and long-term results of conventional aortic valve replacement in high risk patients are excellent with significant lower mortality compared to the EuroSCORE estimation. To date, conventional AVR has still to be considered as gold standard therapy, even in high risk patients.