title: Changes in Risk Profile and Outcomes of Patients Undergoing Surgical Aortic Valve Replacement From the Pre- to Post-Transcatheter Aortic Valve Replacement Eras.
abstract: BACKGROUND
  With initiation of transcatheter aortic valve replacement (TAVR) programs, centers may see changes in surgical aortic valve replacement (SAVR) populations and related outcomes because of more high-risk patients undergoing TAVR rather than SAVR. Little data exist on the potential changes in the risk profiles and outcomes of SAVR patients from the pre- to post-TAVR eras. As such, this study sought to evaluate changes in the SAVR population at a tertiary referral center after TAVR program initiation.
  
  
  METHODS
  Using a single-center valve surgical database, annual volume, patient characteristics, operative details, and predicted and observed mortality for patients undergoing isolated SAVR or SAVR + coronary artery bypass grafting (CABG) from 2006 to 2013 were evaluated. Patients were divided into 3 eras: (1) pre-TAVR (January 2006-June 2009), (2) transition (July 2009-March 2011), and (3) TAVR (April 2011-June 2013). The primary analysis compared predicted and observed mortality in pre-TAVR and TAVR eras.
  
  
  RESULTS
  From 2006 to 2013, 1,380 SAVR patients were identified, with 505 (36.6%), 330 (23.9%), and 545 (39.5%) patients from the pre-TAVR, transition, and TAVR eras, respectively. SAVR case volume increased from 131 to 256 cases per year (95.4% increase) from the pre-TAVR to the post-TAVR eras. Predicted risk of mortality (PROM) for SAVR patients from the pre-TAVR to TAVR eras by The Society of Thoracic Surgeons (STS)-PROM was stable near 3.8% (p = 0.82). Crude 30-day SAVR mortality trended down from 2.8% in the pre-TAVR era to 1.5% in the post-TAVR era (p = 0.23).
  
  
  CONCLUSIONS
  Consistent with previous studies, initiation of a TAVR program was associated with increased SAVR volume. Risk profiles for SAVR patients in the TAVR era remained similar by the STS-PROM, indicating generally stable risk among surgical patients after launching a TAVR program. These data suggest that significant changes in the risk profiles of SAVR patients should not be expected with the initiation of a TAVR program. Further research will need to reevaluate these changes once TAVR becomes more widely available.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Englum
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Asvin M
authors.initials: AM
authors.lastname: Ganapathi
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Schechter
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Harrison
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Donald D
authors.initials: DD
authors.lastname: Glower
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: gchad.hughes@duke.edu.
authors.forename: G Chad
authors.initials: GC
authors.lastname: Hughes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome