Bristol Heart Institute, University of Bristol, Bristol, UK.
Interact Cardiovasc Thorac Surg. 2020 Dec 7;31(6):796-802. doi: 10.1093/icvts/ivaa189.
Continuous improvement in the management of patients undergoing surgical aortic valve replacement (SAVR) may have considerably enhanced surgical outcomes including in-hospital mortality and perioperative complications. We aimed to analyse in-hospital mortality and morbidity trends in patients undergoing SAVR in a single centre to provide insights for future benchmarking for transcatheter aortic valve implantation indications.
This was a retrospective study of prospectively collected data from patients undergoing either isolated SAVR or combined with coronary artery bypass grafting (CABG) at the Bristol Heart Institute, UK, from January 2000 to December 2017. Baseline characteristics were extracted and analysed across 3 different eras (2000-2005, 2006-2011 and 2012-2017). Risk-adjusted time trend was obtained from univariate and multivariate logistic regression including all baseline characteristics.
A total of 2719 patients (63.2%) underwent isolated SAVR, and 1581 (36.8%) underwent combined CABG and SAVR during the study period. For patients undergoing SAVR, in-hospital mortality decreased from 2.9% in 2000-2005 to 0.7% in 2012-2017 (risk-adjusted time trend 0.0001). Hospital mortality in patients aged 75-79 and ≥80 years decreased from 5.6% and 5.3% to 0.4% and 2.2%, respectively. Mortality after combined SAVR and CABG did not significantly decrease (from 3.9% in 2000-2005 to 3.5% in 2012-2017; risk-adjusted time trend = 0.62). However, in patients aged ≥80 years, index hospitalization mortality showed a decreasing non-significant trend from 9.8% to 4.8%.
Our findings support the hypothesis that mortality and morbidity rates following SAVR have significantly improved over the years, including for patients at high risk.
主动脉瓣置换术（SAVR）患者管理的持续改进可能显著改善手术结果，包括住院死亡率和围手术期并发症。我们旨在分析单一中心 SAVR 患者的住院死亡率和发病率趋势，为经导管主动脉瓣植入术（TAVI）的适应证提供未来基准的参考。
这是一项回顾性研究，对英国布里斯托尔心脏研究所 2000 年 1 月至 2017 年 12 月期间接受单纯 SAVR 或 SAVR 联合冠状动脉旁路移植术（CABG）的患者前瞻性收集的数据进行分析。提取基线特征，并根据 3 个不同时期（2000-2005 年、2006-2011 年和 2012-2017 年）进行分析。采用单变量和多变量逻辑回归分析所有基线特征，获得风险调整的时间趋势。
在研究期间，共有 2719 例（63.2%）患者接受单纯 SAVR，1581 例（36.8%）患者接受 SAVR 联合 CABG。对于接受 SAVR 的患者，住院死亡率从 2000-2005 年的 2.9%下降至 2012-2017 年的 0.7%（风险调整的时间趋势为 0.0001）。75-79 岁和≥80 岁患者的住院死亡率从 5.6%和 5.3%分别下降至 0.4%和 2.2%。SAVR 联合 CABG 后的死亡率没有显著下降（从 2000-2005 年的 3.9%降至 2012-2017 年的 3.5%；风险调整时间趋势=0.62）。然而，≥80 岁患者的指数住院死亡率从 9.8%降至 4.8%，呈下降趋势，但无统计学意义。
我们的研究结果支持以下假设，即 SAVR 后的死亡率和发病率多年来显著改善，包括高危患者。
