PMID- 32768428
OWN - NLM
STAT- MEDLINE
DCOM- 20210809
LR  - 20210809
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 112
IP  - 1
DP  - 2021 Jul
TI  - Aortic Valve Replacement in Young and Middle-Aged Adults: Current and Potential 
      Roles of TAVR.
PG  - 132-138
LID - S0003-4975(20)31292-3 [pii]
LID - 10.1016/j.athoracsur.2020.05.180 [doi]
AB  - BACKGROUND: Contemporary practice patterns and outcomes for aortic valve 
      replacement (AVR) among young and middle-aged adults are unknown given guideline 
      modifications for surgical AVR (SAVR) and increasing transcatheter AVR (TAVR) 
      acceptance. This study describes SAVR and TAVR use and outcomes using The Society 
      of Thoracic Surgeons (STS) National Databases. METHODS: Adults 18 to 55 years of 
      age in the Congenital Heart Surgery Database (CHSD) and the Adult Cardiac Surgery 
      Database (ACSD) who underwent SAVR or TAVR from 2013 to 2018 were included. 
      Perioperative characteristics and early outcomes were described by valve type. 
      Multivariable regression identified determinants of death, length of hospital 
      stay, and a composite end point of renal failure, persistent neurologic deficit, 
      readmission, and reoperation. RESULTS: The study analyzed 1580 unique CHSD and 
      44,173 ACSD operations, 16% of which were performed in patients with congenital 
      heart disease. Valve use included the following: TAVR, 1%; mechanical, 42%; 
      bioprosthetic, 55%; autograft, 0.6%; homograft, 1.2%; and Ozaki, 0.4%. Over time, 
      TAVR volumes increased by 167%. The 30-day mortality was as follows: TAVR, 3.8%; 
      mechanical, 3.2%; bioprosthetic, 3.7%; autograft, 0.6%; homograft, 9%; and Ozaki, 
      3.4%. Stroke rate was lower for isolated SAVR vs isolated TAVR (0.9% vs 2.4%; P = 
      .002). In multivariable analyses, mortality risk was lower with mechanical 
      valves, congenital morbidity risk was higher with TAVR, and length of stay was 
      shorter with TAVR. CONCLUSIONS: TAVR is increasingly used for adults younger than 
      55 years of age. Given the uniformly excellent results with SAVR, including both 
      mortality and morbidity-particularly regarding stroke, our data favor SAVR in 
      this population, but a prospective trial is needed. Ongoing efforts to harmonize 
      variables and outcomes definitions between the ACSD and CHSD are valuable.
CI  - Copyright (c) 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Nelson, Jennifer S
AU  - Nelson JS
AD  - Department of Cardiovascular Services, Nemours Children's Hospital, Orlando, 
      Florida. Electronic address: jennifer.nelson@nemours.org.
FAU - Maul, Timothy M
AU  - Maul TM
AD  - Department of Cardiovascular Services, Nemours Children's Hospital, Orlando, 
      Florida.
FAU - Wearden, Peter D
AU  - Wearden PD
AD  - Department of Cardiovascular Services, Nemours Children's Hospital, Orlando, 
      Florida.
FAU - Najm, Hani K
AU  - Najm HK
AD  - Division of Pediatric Cardiac Surgery, Heart, Vascular and Thoracic Institute, 
      Cleveland Clinic, Cleveland, Ohio.
FAU - Baloglu, Orkun
AU  - Baloglu O
AD  - Department of Pediatric Critical Care Medicine, Pediatric Institute, Cleveland 
      Clinic Children's, Cleveland, Ohio.
FAU - Johnston, Douglas R
AU  - Johnston DR
AD  - Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic 
      Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Karamlou, Tara
AU  - Karamlou T
AD  - Division of Pediatric Cardiac Surgery, Heart, Vascular and Thoracic Institute, 
      Cleveland Clinic, Cleveland, Ohio.
LA  - eng
PT  - Journal Article
DEP - 20200806
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adult
MH  - Aortic Valve/*surgery
MH  - Databases, Factual
MH  - Female
MH  - Heart Defects, Congenital/surgery
MH  - *Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/adverse effects/methods/*trends
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/mortality
MH  - Prosthesis Design/trends
MH  - Transcatheter Aortic Valve Replacement/*trends
MH  - Young Adult
EDAT- 2020/08/10 06:00
MHDA- 2021/08/10 06:00
CRDT- 2020/08/10 06:00
PHST- 2020/01/28 00:00 [received]
PHST- 2020/05/08 00:00 [revised]
PHST- 2020/05/27 00:00 [accepted]
PHST- 2020/08/10 06:00 [pubmed]
PHST- 2021/08/10 06:00 [medline]
PHST- 2020/08/10 06:00 [entrez]
AID - S0003-4975(20)31292-3 [pii]
AID - 10.1016/j.athoracsur.2020.05.180 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2021 Jul;112(1):132-138. doi: 10.1016/j.athoracsur.2020.05.180. 
      Epub 2020 Aug 6.