title: Surgical aortic valve replacement outcomes in the transcatheter era.
abstract: BACKGROUND
  The primary objective of this study was to evaluate the influence of transcatheter aortic valve implantation (TAVI) on the characteristics and outcomes of patients undergoing surgical aortic valve replacement (SAVR) in a single high-volume Canadian center.
  
  
  METHODS
  Between January 2003 and December 2013, 1593 patients underwent isolated SAVR at our institution. The study period was divided into 2 distinct cohorts of patients undergoing SAVR: before (n = 529) and after (n = 1064) the first TAVI procedure in May 2007. We compared the risk profiles and clinical outcomes of the 2 cohorts and assessed the multivariate predictors of in-hospital mortality.
  
  
  RESULTS
  The ratio of isolated SAVR to the total number of cardiac surgery cases per year rose significantly after the introduction of TAVI (7.2% vs 9.1%; P < .0001). There was significantly more diabetes, obesity, recent myocardial infarction, and use of a bioprosthesis among SAVR patients in the post-TAVI era (all P values < .05). In-hospital mortality decreased significantly among SAVR patients following the introduction of TAVI (3.6% vs 1.8%; P = .03). Independent risk factors for in-hospital mortality among the entire study population were SAVR in the pre-TAVI era, baseline creatinine, age, and prosthesis size ≤ 21 mm for the pre-TAVI group only.
  
  
  CONCLUSIONS
  The number of isolated SAVR cases increased following the introduction of TAVI. There was a significant reduction in operative mortality of SAVR in the post-TAVI era despite greater severity of several markers of risk. Patient referrals for TAVI should take into consideration the changing risk profiles and improved results of conventional surgery.
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Martin
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Dagenais
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Charbonneau
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Baillot
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Kalavrouziotis
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: siamak.mohammadi@fmed.ulaval.ca.
authors.forename: Siamak
authors.initials: S
authors.lastname: Mohammadi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D006348:Cardiac Surgical Procedures; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome
keywords: aortic valve replacement; mortality; risk stratification; transcatheter aortic valve implantation