title: Contemporary results for isolated aortic valve surgery.
abstract: BACKGROUND
  We aimed to give an overview of the contemporary status of aortic valve replacement.
  
  
  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 EuroSCORE < 10 or an expected mortality < 20 %. In-hospital 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.
authors.affiliation: Division of Cardiac Surgery, Catholic University, Rome, Italy. mgaudino@tiscali.it
authors.forename: M
authors.initials: M
authors.lastname: Gaudino
authors.forename: A
authors.initials: A
authors.lastname: Anselmi
authors.forename: F
authors.initials: F
authors.lastname: Glieca
authors.forename: V
authors.initials: V
authors.lastname: Tsiopoulos
authors.forename: C
authors.initials: C
authors.lastname: Pragliola
authors.forename: M
authors.initials: M
authors.lastname: Morelli
authors.forename: G
authors.initials: G
authors.lastname: Possati
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D016009:Chi-Square Distribution; D005260:Female; D006324:Heart Arrest, Induced; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography