title: What has changed in surgical treatment of severe aortic stenosis with the advent of percutaneous intervention?
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) is an alternative therapeutic approach to patients not considered suitable for surgical aortic valve replacement (SAVR) due to their high operative risk. We sought to assess the impact of TAVI on the profile and operative results of patients with severe aortic stenosis undergoing SAVR.
  
  
  METHODS
  A total of 214 patients were included, of whom 103 consecutive patients underwent isolated SAVR in 2005 and 111 in 2009. Patients' demographic and operative data were collected retrospectively. Operative and one-year mortality and morbidity were analyzed.
  
  
  RESULTS
  Patients' mean age was 70 years, and 56% were female. Following the introduction of a TAVI program, patients undergoing conventional surgery were older, with more comorbidities. Overall 30-day and one-year mortality were 2.8% and 7.0%, respectively. After the introduction of TAVI, the observed mortality rate for SAVR decreased, but not significantly (operative mortality: 3.9% before TAVI vs. 1.8% after TAVI, p = NS; one-year mortality: 10% vs. 4.5%, p = NS). Striking differences were observed in morbidity (operative morbidity: 23.3% before TAVI vs. 13.5% after TAVI, p = 0.047, and one-year morbidity: 20.4% vs. 9.9%, p = 0.032).
  
  
  CONCLUSIONS
  Since the introduction of a TAVI program at our center, the number of patients undergoing SAVR has increased, with a slight rise in surgical risk, but without worsening the final operative results. The implementation of a TAVI program has thus had a positive impact on the volume of procedures, patient selection and outcomes in SAVR.
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal. Electronic address: eulaliaalvespereira@gmail.com.
authors.forename: Eulália
authors.initials: E
authors.lastname: Pereira
authors.forename: Guida
authors.initials: G
authors.lastname: Silva
authors.forename: Daniel
authors.initials: D
authors.lastname: Caeiro
authors.forename: Marlene
authors.initials: M
authors.lastname: Fonseca
authors.forename: Francisco
authors.initials: F
authors.lastname: Sampaio
authors.forename: Conceição
authors.initials: C
authors.lastname: Fonseca
authors.forename: João
authors.initials: J
authors.lastname: Primo
authors.forename: Lino
authors.initials: L
authors.lastname: Simões
authors.forename: Luís
authors.initials: L
authors.lastname: Vouga
authors.forename: Vasco
authors.initials: V
authors.lastname: Gama
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002404:Catheterization; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Aortic stenosis; Cirurgia de substituição valvular aórtica; Estenose aórtica severa; Heart valve prosthesis implantation; Implantação percutânea de próteses valvulares aórticas; Transcatheter aortic valve implantation