Reintervention rates following bioprosthetic surgical aortic valve replacement—a Danish Nationwide Cohort Study

• Published in: European journal of cardio-thoracic surgery 2022-02, Vol.61 (3), p.614-622
• Main Authors: Schmiegelow, Michelle D S, Elming, Hanne, Sibilitz, Kirstine L, Bruun, Niels E, Carranza, Christian L, Dahl, Jordi S, Fosbøl, Emil, Køber, Lars, Torp-Pedersen, Christian, Schmiegelow, Søren S
• Format: Article
• Language: English
• Subjects: Aortic Valve - surgery; Aortic Valve Stenosis - surgery; Cohort Studies; Denmark - epidemiology; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis Implantation - methods; Humans; Risk Factors; Transcatheter Aortic Valve Replacement - methods; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezab365

Abstract   OBJECTIVES Updated European guidelines recommend annual echocardiographic evaluation after bioprosthetic surgical aortic valve replacement (bio-SAVR). Given the increased demand on health care resources, only clinically relevant controls can be prioritized. We therefore aimed to explore reintervention rates following bio-SAVR. METHODS From the nationwide Danish Register of Surgical Procedures, we identified all patients ≥40 years with isolated bio-SAVR ± concomitant coronary artery bypass graft surgery (CABG) during 2000–2016. In 90-day reintervention-free survivors, we assessed aortic valve reintervention rates (primary outcome) and all-cause mortality rates (secondary outcome) at 1, 3 and 5 years with total follow-up until 31 December 2017 and further estimated annual theoretical echocardiographic control visits. RESULTS In 10 518 patients with bio-SAVR (+CABG 39.7%), we observed low reintervention rates at 1, 3 and 5 years, but with high rates of all-cause mortality; i.e. 5-year reintervention rate of 3.7/1000 person-years (≤1.5%) and 5-year mortality rate of 21.7/1000 person-years. Accounting for the competing risk of death, 5-year rates were inversely related to age group and remained relatively low across all age categories but increased gradually in the long term. A significant proportion of reinterventions were presumed due to infectious endocarditis (48% at 3 years, 37% at 5 years). With annual transthoracic echocardiography, the theoretical ratio of echocardiographies per reintervention in the first 5 years was 248, and 425 when endocarditis events were excluded. CONCLUSION Reintervention rates within the first 5 years following bio-SAVR were relatively rare, and with a substantial number due to endocarditis. Improved life expectancy [1] has resulted in an expanding elderly population with an increased prevalence of valvular heart disease and consequently an increased need for valve surgery, which adds to the growing burden on the healthcare systems worldwide.