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Original research article
Morbidity outcomes after surgical aortic valve replacement
  1. Andreas Auensen1,
  2. Amjad Iqbal Hussain2,
  3. Bjørn Bendz1,
  4. Lars Aaberge1,
  5. Ragnhild Sørum Falk3,
  6. Marte Meyer Walle-Hansen4,
  7. Jorun Bye4,
  8. Johanna Andreassen1,
  9. Jan Otto Beitnes5,
  10. Kjell Arne Rein6,
  11. Kjell Ingar Pettersen1 and
  12. Lars Gullestad7
  1. 1 Department of Cardiology, Faculty of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
  2. 2 Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
  3. 3 Oslo Center for Biostatistics and Epidemiology, Oslo, Norway
  4. 4 Faculty of Medicine, University of Oslo, Oslo, Norway
  5. 5 Department of Cardiology, Oslo University Hospital, Oslo, Norway
  6. 6 Department of Cardiothoracic Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
  7. 7 Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
  1. Correspondence to Andreas Auensen; andreasauensen{at}gmail.com

Abstract

Objective In patients with mild to moderate operative risk, surgical aortic valve replacement (SAVR) is still the preferred treatment for patients with severe symptomatic aortic stenosis (AS). Aiming to broaden the knowledge of postsurgical outcomes, this study reports a broad set of morbidity outcomes following surgical intervention.

Methods Our cohort comprised 442 patients referred for severe AS; 351 had undergone SAVR, with the remainder (91) not operated on. All patients were evaluated using the 6-minute walk test (6MWT), were assigned a New York Heart Association class (NYHA) and Canadian Cardiovascular Society class (CCS), with additional scores for health-related quality of life (HRQoL), cognitive function (Mini-Mental State Examination (MMSE)) and myocardial remodelling (at inclusion and at 1-year follow-up). Adverse events and mortality were recorded.

Results Three-year survival after SAVR was 90.0%. SAVR was associated with an improved NYHA class, CCS score and HRQoL, and provoked reverse ventricular remodelling. The 6MWT decreased, while the risks of major adverse cardiovascular events (death, non-fatal stroke/transient ischaemic attack or myocardial infarction) and all-cause hospitalisation (incidence rate per 100 patient-years) were 13.5 and 62.4, respectively. The proportion of cognitive disability measured by MMSE increased after SAVR from 3.2% to 8.8% (p=0.005). Proportion of patients living independently at home, having attained NYHA class I, was met by 49.1% at 1 year. Unoperated individuals had a poor prognosis in terms of any outcome.

Conclusion This study provides knowledge of outcomes beyond what is known about the mortality benefit after SAVR to provide insight into the morbidity burden of modern-day SAVR.

  • Aortic valvne disease
  • Surgery -valve
  • Quality of care and outcomes

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Competing interests None declared.

  • Ethics approval Regional Ethics Committee (REK sør-øst).

  • Provenance and peer review Not commissioned; internally peer reviewed

  • Data sharing statement No additional data are available.

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