title: Is Surgical Intervention the Optimal Therapy for the Treatment of Aortic Valve Stenosis for Patients With Intermediate Society of Thoracic Surgeons Risk Score?
abstract: BACKGROUND
  Patients at intermediate risk (IR) according to The Society of Thoracic Surgeons risk score are today frequently oriented toward the transfemoral aortic valve replacement (TAVR) option. Our goal was to evaluate the best treatment strategies for IR patients with severe aortic stenosis.
  
  
  METHODS
  Of a consecutive series of 1,144 surgical aortic valve replacements (AVRs) performed in our institution between 2008 and 2014, we reviewed the early and late outcomes of two different groups: a low-risk (LR) group of 470 patients, and an IR group of 620. We eliminated from the analysis 54 high-risk patients who were currently candidates for TAVR. All patients underwent surgical AVR with or without concomitant coronary artery bypass grafting. Social Security database interrogation provided long-term information.
  
  
  RESULTS
  The early mortality rate (30 days) between LR and IR patients was similar (1.70% vs 2.74%, p = 0.25) and both lower than predicted mortality rates. However, cumulative 5-year survival was significantly higher in LR patients (86.3%) than in IR patients (75.4%; p = 0.0007 by log-rank test), although excellent in IR group. Comparing IR survivors and nonsurvivors, ages at operation were 69.5 ± 12.7 years for survivors vs 75.4 ± 9.6 years for those experiencing late deaths (p = 0.002). Risk factors for late deaths after multivariate analysis were age, hemodialysis, and chronic lung disease.
  
  
  CONCLUSIONS
  Most IR patients today should undergo surgical AVR, but because of survival rates combined with still unavailable late structural deterioration rates in TAVR valves, patients in the IR group with high Society of Thoracic Surgeons scores and known risk factors may be better served with TAVR as data regarding late percutaneous valve function accrue.
authors.affiliation: Asheville Heart, Asheville, North Carolina.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Groh
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Ivan
authors.initials: I
authors.lastname: Diaz
authors.affiliation: Asheville Heart, Asheville, North Carolina.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Johnson
authors.affiliation: Asheville Heart, Asheville, North Carolina.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Ely
authors.affiliation: Asheville Heart, Asheville, North Carolina.
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Binns
authors.affiliation: Clinical Research, Mission Hospital, Asheville, North Carolina. Electronic address: gerard@champsaur-consulting.com.
authors.forename: Gerard L
authors.initials: GL
authors.lastname: Champsaur
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome