Age-Stratified Surgical Aortic Valve Replacement for Aortic Stenosis

Christopher K. Mehta; Tom X. Liu; Levi Bonnell; Robert H. Habib; Tsuyoshi Kaneko; James D. Flaherty; Charles J. Davidson; James D. Thomas; Vera H. Rigolin; Robert O. Bonow; Duc Thinh Pham; Douglas R. Johnston; Patrick M. McCarthy; S. Chris Malaisrie

doi:10.1016/j.athoracsur.2024.01.013

Age-Stratified Surgical Aortic Valve Replacement for Aortic Stenosis

Christopher K. Mehta^*, Tom X. Liu, Levi Bonnell, Robert H. Habib, Tsuyoshi Kaneko, James D. Flaherty, Charles J. Davidson, James D. Thomas, Vera H. Rigolin, Robert O. Bonow, Duc Thinh Pham, Douglas R. Johnston, Patrick M. McCarthy, S. Chris Malaisrie

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Background: The management of aortic stenosis has evolved to stratification by age as reflected in recent societal guidelines. We evaluated age-stratified surgical aortic valve replacement (SAVR) trends and outcomes in patients with bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV) from The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Methods: This cohort included adults (≥18 years) undergoing SAVR for severe aortic stenosis between July 2011 and December 2022. Comparisons were stratified by age (<65 years, 65-79 years, ≥80 years) and BAV or TAV status. Primary end points included operative mortality, composite morbidity and mortality, and permanent stroke. Observed to expected ratios by The Society of Thoracic Surgeons predicted risk of mortality were calculated. Results: In total, 200,849 SAVR patients (55,326 BAV [27.5%], 145,526 TAV [72.5%]) from 1238 participating hospitals met study criteria. Annual SAVR volumes decreased by 45% (19,560 to 10,851) during the study period. The decrease was greatest (96%) for patients ≥80 years of age (4914 to 207). The relative prevalence of BAV was greater in younger patients (<65 years, 69,068 [49.5% BAV]; 65-79 years, 104,382 [19.1% BAV]; ≥80 years, 27,399 [4.5% BAV]). The observed mortality in <80-year-old BAV patients (<65 years, 1.08; 65-79 years, 1.21; ≥80 years, 3.68) was better than the expected mortality rate (<65 years, 1.22; 65-79 years, 1.54; ≥80 years, 3.14). Conclusions: SAVR volume in the transcatheter era has decreased substantially, particularly for patients ≥80 years old and for those with TAV. Younger patients with BAV have better than expected outcomes, which should be carefully considered during shared decision-making in the treatment of aortic stenosis. SAVR should remain the preferred therapy in this population.

Original language	English (US)
Pages (from-to)	430-438
Number of pages	9
Journal	Annals of Thoracic Surgery
Volume	118
Issue number	2
DOIs	https://doi.org/10.1016/j.athoracsur.2024.01.013
State	Published - Aug 2024

Funding

The authors have no funding sources to disclose. Christopher K. Mehta reports a relationship with W. L. Gore and Associates that includes: consulting or advisory, funding grants, and speaking and lecture fees; and with Baxter that includes: speaking and lecture fees. Tsuyoshi Kaneko reports a relationship with Edwards Lifesciences Corporation that includes: consulting or advisory; with Abbott that includes: consulting or advisory; with Johnson and Johnson Ltd that includes: consulting or advisory; and with Medtronic that includes: consulting or advisory. Charles J. Davidson reports a relationship with Edwards Lifesciences Corporation that includes: consulting or advisory and funding grants; and with Abbott that includes: funding grants. James D. Thomas reports a relationship with General Electric Company that includes: consulting or advisory; with Egnite LLC that includes: consulting or advisory; with Abbott that includes: consulting or advisory; with Caption Health that includes: consulting or advisory; and with EchoIQ that includes: consulting or advisory. Duc Thinh Pham reports a relationship with Abbott that includes: consulting or advisory; with AbioMed Inc that includes: consulting or advisory; and with Medtronic Inc that includes: consulting or advisory. Douglas R. Johnston reports a relationship with Abbott that includes: consulting or advisory; with Edwards Lifesciences Corporation that includes: consulting or advisory; with Terumo Cardiovascular Systems Corp that includes: consulting or advisory; with LivaNova USA, Inc that includes: consulting or advisory; and with HD Medical Inc that includes: consulting or advisory. Patrick M. McCarthy reports a relationship with Edwards Lifesciences Corporation that includes: consulting or advisory and speaking and lecture fees; with Medtronic Inc that includes: speaking and lecture fees; with AtriCure Inc that includes: speaking and lecture fees; and with Egnite that includes: past consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

ASJC Scopus subject areas

Surgery
Pulmonary and Respiratory Medicine
Cardiology and Cardiovascular Medicine

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10.1016/j.athoracsur.2024.01.013

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Mehta, C. K., Liu, T. X., Bonnell, L., Habib, R. H., Kaneko, T., Flaherty, J. D., Davidson, C. J., Thomas, J. D., Rigolin, V. H., Bonow, R. O., Pham, D. T., Johnston, D. R., McCarthy, P. M., & Malaisrie, S. C. (2024). Age-Stratified Surgical Aortic Valve Replacement for Aortic Stenosis. Annals of Thoracic Surgery, 118(2), 430-438. https://doi.org/10.1016/j.athoracsur.2024.01.013

@article{6400745eef2c471ab5e619dae150529f,

title = "Age-Stratified Surgical Aortic Valve Replacement for Aortic Stenosis",

abstract = "Background: The management of aortic stenosis has evolved to stratification by age as reflected in recent societal guidelines. We evaluated age-stratified surgical aortic valve replacement (SAVR) trends and outcomes in patients with bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV) from The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Methods: This cohort included adults (≥18 years) undergoing SAVR for severe aortic stenosis between July 2011 and December 2022. Comparisons were stratified by age (<65 years, 65-79 years, ≥80 years) and BAV or TAV status. Primary end points included operative mortality, composite morbidity and mortality, and permanent stroke. Observed to expected ratios by The Society of Thoracic Surgeons predicted risk of mortality were calculated. Results: In total, 200,849 SAVR patients (55,326 BAV [27.5%], 145,526 TAV [72.5%]) from 1238 participating hospitals met study criteria. Annual SAVR volumes decreased by 45% (19,560 to 10,851) during the study period. The decrease was greatest (96%) for patients ≥80 years of age (4914 to 207). The relative prevalence of BAV was greater in younger patients (<65 years, 69,068 [49.5% BAV]; 65-79 years, 104,382 [19.1% BAV]; ≥80 years, 27,399 [4.5% BAV]). The observed mortality in <80-year-old BAV patients (<65 years, 1.08; 65-79 years, 1.21; ≥80 years, 3.68) was better than the expected mortality rate (<65 years, 1.22; 65-79 years, 1.54; ≥80 years, 3.14). Conclusions: SAVR volume in the transcatheter era has decreased substantially, particularly for patients ≥80 years old and for those with TAV. Younger patients with BAV have better than expected outcomes, which should be carefully considered during shared decision-making in the treatment of aortic stenosis. SAVR should remain the preferred therapy in this population.",

author = "Mehta, {Christopher K.} and Liu, {Tom X.} and Levi Bonnell and Habib, {Robert H.} and Tsuyoshi Kaneko and Flaherty, {James D.} and Davidson, {Charles J.} and Thomas, {James D.} and Rigolin, {Vera H.} and Bonow, {Robert O.} and Pham, {Duc Thinh} and Johnston, {Douglas R.} and McCarthy, {Patrick M.} and Malaisrie, {S. Chris}",

note = "Publisher Copyright: {\textcopyright} 2024 The Society of Thoracic Surgeons",

year = "2024",

month = aug,

doi = "10.1016/j.athoracsur.2024.01.013",

language = "English (US)",

volume = "118",

pages = "430--438",

journal = "Annals of Thoracic Surgery",

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T1 - Age-Stratified Surgical Aortic Valve Replacement for Aortic Stenosis

AU - Mehta, Christopher K.

AU - Liu, Tom X.

AU - Bonnell, Levi

AU - Habib, Robert H.

AU - Kaneko, Tsuyoshi

AU - Flaherty, James D.

AU - Davidson, Charles J.

AU - Thomas, James D.

AU - Rigolin, Vera H.

AU - Bonow, Robert O.

AU - Pham, Duc Thinh

AU - Johnston, Douglas R.

AU - McCarthy, Patrick M.

AU - Malaisrie, S. Chris

PY - 2024/8

Y1 - 2024/8

N2 - Background: The management of aortic stenosis has evolved to stratification by age as reflected in recent societal guidelines. We evaluated age-stratified surgical aortic valve replacement (SAVR) trends and outcomes in patients with bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV) from The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Methods: This cohort included adults (≥18 years) undergoing SAVR for severe aortic stenosis between July 2011 and December 2022. Comparisons were stratified by age (<65 years, 65-79 years, ≥80 years) and BAV or TAV status. Primary end points included operative mortality, composite morbidity and mortality, and permanent stroke. Observed to expected ratios by The Society of Thoracic Surgeons predicted risk of mortality were calculated. Results: In total, 200,849 SAVR patients (55,326 BAV [27.5%], 145,526 TAV [72.5%]) from 1238 participating hospitals met study criteria. Annual SAVR volumes decreased by 45% (19,560 to 10,851) during the study period. The decrease was greatest (96%) for patients ≥80 years of age (4914 to 207). The relative prevalence of BAV was greater in younger patients (<65 years, 69,068 [49.5% BAV]; 65-79 years, 104,382 [19.1% BAV]; ≥80 years, 27,399 [4.5% BAV]). The observed mortality in <80-year-old BAV patients (<65 years, 1.08; 65-79 years, 1.21; ≥80 years, 3.68) was better than the expected mortality rate (<65 years, 1.22; 65-79 years, 1.54; ≥80 years, 3.14). Conclusions: SAVR volume in the transcatheter era has decreased substantially, particularly for patients ≥80 years old and for those with TAV. Younger patients with BAV have better than expected outcomes, which should be carefully considered during shared decision-making in the treatment of aortic stenosis. SAVR should remain the preferred therapy in this population.

AB - Background: The management of aortic stenosis has evolved to stratification by age as reflected in recent societal guidelines. We evaluated age-stratified surgical aortic valve replacement (SAVR) trends and outcomes in patients with bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV) from The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Methods: This cohort included adults (≥18 years) undergoing SAVR for severe aortic stenosis between July 2011 and December 2022. Comparisons were stratified by age (<65 years, 65-79 years, ≥80 years) and BAV or TAV status. Primary end points included operative mortality, composite morbidity and mortality, and permanent stroke. Observed to expected ratios by The Society of Thoracic Surgeons predicted risk of mortality were calculated. Results: In total, 200,849 SAVR patients (55,326 BAV [27.5%], 145,526 TAV [72.5%]) from 1238 participating hospitals met study criteria. Annual SAVR volumes decreased by 45% (19,560 to 10,851) during the study period. The decrease was greatest (96%) for patients ≥80 years of age (4914 to 207). The relative prevalence of BAV was greater in younger patients (<65 years, 69,068 [49.5% BAV]; 65-79 years, 104,382 [19.1% BAV]; ≥80 years, 27,399 [4.5% BAV]). The observed mortality in <80-year-old BAV patients (<65 years, 1.08; 65-79 years, 1.21; ≥80 years, 3.68) was better than the expected mortality rate (<65 years, 1.22; 65-79 years, 1.54; ≥80 years, 3.14). Conclusions: SAVR volume in the transcatheter era has decreased substantially, particularly for patients ≥80 years old and for those with TAV. Younger patients with BAV have better than expected outcomes, which should be carefully considered during shared decision-making in the treatment of aortic stenosis. SAVR should remain the preferred therapy in this population.

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Age-Stratified Surgical Aortic Valve Replacement for Aortic Stenosis

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