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Cardiovascular medicine
Original research
Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database
  1. Marjan Jahangiri1,
  2. Rajdeep Bilkhu2,
  3. Andrew Embleton-Thirsk3,
  4. Hakim-Moulay Dehbi3,
  5. Krishna Mani1,
  6. Jon Anderson4,
  7. Vassilios Avlonitis2,
  8. Max Baghai5,
  9. Inderpaul Birdi6,
  10. Karen Booth7,
  11. Amal Bose8,
  12. Norman Briffa9,
  13. Keith Buchan10,
  14. Sunil Bhudia11,
  15. Alex Cale12,
  16. Indu Deglurkar13,
  17. Shakil Farid14,
  18. Leonidas Hadjinikolaou15,
  19. Martin Jarvis16,
  20. Seyed Hossein Javadpour17,
  21. Reubendra Jeganathan18,
  22. Manoj Kuduvalli19,
  23. Kulvinder Lall20,
  24. Jorge Mascaro21,
  25. Dheeraj Mehta13,
  26. Sunil Ohri22,
  27. Prakash Punjabi4,
  28. Rajamiyer Venkateswaran23,
  29. Paul Ridley24,
  30. Christopher Satur24,
  31. Serban Stoica25,
  32. Uday Trivedi26,
  33. Afzal Zaidi27,
  34. Patrick Yiu28,
  35. Narain Moorjani29,
  36. Simon Kendall30,
  37. Nick Freemantle31
  1. 1Department of Cardiac Surgery, St George’s Hospital, London, UK
  2. 2Department of Cardiac Surgery, St Thomas’ Hospital, London, UK
  3. 3University College London Institute of Clinical Trials and Methodology, London, UK
  4. 4Department of Cardiac Surgery, Hammersmith Hospital, London, UK
  5. 5Department of Cardiac Surgery, King’s College Hospital, London, UK
  6. 6Department of Cardiac Surgery, Essex Cardiothoracic Centre, Basildon, UK
  7. 7Department of Cardiac Surgery, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK
  8. 8Department of Cardiac Surgery, Lancashire Cardiac Centre, Blackpool, UK
  9. 9Sheffield Teaching Hospitals NHS Foundation Trust Cardiothoracic Centre, Sheffield, UK
  10. 10Department of Cardiac Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
  11. 11Harefield Hospital Heart Surgery, London, UK
  12. 12Department of Cardiac Surgery, Castle Hill Hospital, Cottingham, UK
  13. 13Department of Cardiac Surgery, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
  14. 14Department of Cardiac Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
  15. 15Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
  16. 16Department of Cardiac Surgery, Hull University Teaching Hospitals NHS Trust, Hull, UK
  17. 17Department of Cardiac Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
  18. 18Department of Cardiac Surgery, Royal Victoria Hospital, Belfast, UK
  19. 19Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
  20. 20Saint Bartholomew’s Hospital Barts Heart Centre, London, UK
  21. 21Department of Cardiac Surgery, Queen Elizabeth Medical Centre, Birmingham, UK
  22. 22Department of Cardiac Surgery, Southampton University Hospitals NHS Trust, Southampton, UK
  23. 23Wythenshawe Hospital North West Heart Centre, Manchester, UK
  24. 24Department of Cardiac Surgery, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
  25. 25Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
  26. 26Royal Sussex County Hospital Sussex Cardiac Centre, Brighton, UK
  27. 27Department of Cardiac Surgery, Morriston Hospital, Swansea, UK
  28. 28Department of Cardiac Surgery, New Cross Hospital, Wolverhampton, UK
  29. 29Department of Cardiac Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
  30. 30Department of Cardiac Surgery, James Cook University Hospital, Middlesbrough, UK
  31. 31Comprehensive Clinical Trials Unit, University College London Institute of Clinical Trials and Methodology, London, UK
  1. Correspondence to Professor Marjan Jahangiri; marjan.jahangiri{at}stgeorges.nhs.uk

Abstract

Objectives To date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore ‘real-world’ practice.

Design Retrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants’ demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed.

Setting 27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis.

Participants 31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG.

Results In-hospital mortality for isolated SAVR was 1.9% (95% CI 1.6% to 2.1%) and was 2.4% for AVR+CABG. Mortality by age category for SAVR only were: <60 years=2.0%, 60–75 years=1.5%, >75 years=2.2%. For SAVR+CABG these were; 2.2%, 1.8% and 3.1%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3%, in intermediate risk 1% and for high risk 3.9%. 74.3% of the operations were elective, 24% urgent and 1.7% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9% and 1.1%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes.

Conclusions Surgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease.

  • cardiothoracic surgery
  • cardiac surgery
  • cardiology

Data availability statement

Data are available on reasonable request. Requests on data sharing can be made by contacting the corresponding author. Data will be shared after review and approval by the authors and terms of collaboration will be reached together with a signed data access agreement.

http://creativecommons.org/licenses/by-nc/4.0/

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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-046491

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    Data availability statement

    Data are available on reasonable request. Requests on data sharing can be made by contacting the corresponding author. Data will be shared after review and approval by the authors and terms of collaboration will be reached together with a signed data access agreement.

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    Footnotes

    • RB and AE-T contributed equally.

    • Contributors The first five authors and the senior author have designed this project, compile the data set, collected, analysed the data and reviewed the various versions of the manuscript. Other authors have collated, validated and submitted their data on behalf of their unit. They have assisted in the design and analysis of the manuscript. In addition,each author has cointributed to the various verisons of the manuscipt with constructive comments. Every author has contributed to the interpretation of data. More specifically: MJah: Thought of the concept, designed the project, plan data collection, identified units, approached each unit, collected and analysed the data. Wrote the first draft and author for subsequesnt versions. RB: thought of the concept, designed the project, planned data collection, collected the data and cleaned it, contribuited significantly to writing major sections of the paper. AE-T: Involved in the design of the study at the outset, of the two main statistician who carried out the statistical work. Attended several meetings to discuss the project, involed in writing all the versions. H-MD: Involved in the design of the study at the outset, of the two main statistician who carried out the statistical work. Attended several meetings to discuss the project, involed in writing all the versions. KM: thought of the concept, designed the project, planned data collection, collected the data and cleaned it, contribuited significantly to writing major sections of the paper, checked the literature contents and references. JA: Planned the project with the first two authors, acquired the data and contributed to several verisons during the wiriing up phase. VA: Planned the project with the first two authors, acquired the data and contributed to several verisons during the wirting up phase. MB: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase. IB: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase. KBo: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase. NB: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase. KBu: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase. SB: Planned the project with the first two authors, acquired the data and contributed to several verisons during the wiriing up phase14. AC: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase15. ID: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase16. SF: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase17. LH: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase18. MJar: Planned the project with the first two authors, acquired the data and contributed to several verisons during the wiriing up phase19. SHJ: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase20. RJ: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase 9. Inder21. MK: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase22. KL: Planned the project with the first two authors, acquired the data 23. JM: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase24. DM: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase25. SO: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase26. PP: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase27. RV: Planned the project with the first two authors, acquired the data and contributed to several verisons during the wirting up phase28. PR: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase29. CS: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase30. SS: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase31. UT: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase32. AZ: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase33. PY: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase34. NM: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase. Facilitated the acquisition of thedata through the Society for Cardiothoracic Surgery of GB & Ireland.35. SK: Planned the project with the first two authors, acquired the data and contributed to several verisons during the writing up phase. Facilitated the acquisition of thedata through the Society for Cardiothoracic Surgery of GB & Ireland.36. NF: Senior statistician who designed the project, defiend the original plan for the study, assisted the other two statistician to analyse the data, took part in several meetings interpreting the data with further analysis,assisted in writing the paper and final analysis

    • Funding We would like to expess our gratitude to Edwards Lifesciences for their support for a part time research person and administrator for this study.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.