Contemporary Results for Isolated Aortic Valve Surgery

Background: We aimed to give an overview of the contemporary status of aortic valve replacement. Materials and Methods: This single-center prospective study was initiated in January 2003. From this date on, every patient with aortic valve disease admitted to our hospital was reviewed by a cardiologist and a surgeon to determine eligibility for replacement. In no instance was the operation denied in the absence of surgical consultation. All operations were performed using a median sternotomy, with cardiopulmonary bypass and cardioplegic arrest. Results: A total of 873 cases were screened until the end of the study. We identified three groups of patients: Group 1 (inoperable cases) consisted of 15 patients (1%); Group 2 (high-risk cases) included 99 patients with an additive EuroSCORE >= 10 or an expected mortality > 20% (logistic model); Group 3 (moderate-to low-risk cases) consisted of 759 patients with an additive Euro-SCORE < 10 or an expected mortality < 20%. Inhospital mortality was 6.0% (6/99) for Group 2 and 0.3% (3/759) for Group 3. Major complications occurred in 5 patients of Group 2 (5%) and in 9 patients of Group 3 (1.1%). At predischarge echocardiography, 99.3% of the implanted valves were perfect. At a follow-up of 28.9 +/- 12.3 months 798/849 patients were alive; 89% of them (711) were in NYHA 1-2. Conclusions: Surgical aortic valve replacement provides excellent results and has a low operative mortality even in high-risk patients. Surgical consultation for every aortic patient resulted in an extremely low rate of surgery refusals. Our data should be regarded as a benchmark for transcatheter techniques.