Midterm Outcomes after Surgical Aortic Valve Replacement with a Bioprosthetic Valve from the Multicenter IMPACT Registry

Background: The midterm outcome reports on the surgical aortic valve replacement (SAVR) using bioprosthestic valves in young patients with pre-existing comorbidities, including hemodynamic performance and durability of the valve, are scarce.

Methods: IMPACT is a prospective, multicenter, international registry with a 5-year follow-up to determine all-cause and valve-related mortality as well as hemodynamic performance in patients undergoing SAVR with a novel bioprosthetic valve. Here we report the 3-year follow-up results in a total population of 556 patients.

Results: The mean age was 63.4 ± 8.5 years, and 29.0% were female, with a EuroSCORE II of 2.2 ± 2.5% and STS score of 1.7 ± 2.2%. Hypertension (66.2%), coronary artery disease (34.7%), and diabetes (18.4%) were the most common comorbidities. 49.3% of the patients underwent full sternotomy, 58.3% isolated AVR and 23 mm (35.4%) and 25 mm (30.9%) were the most commonly used valves. At 3 years, overall survival was 93.4%, while freedom from valve-related mortality was 97.5%. Freedom from prosthetic endocarditis was 97.0% and from stroke 95.5%; freedom from structural valve deterioration (Stage 2), valve-related dysfunction, and reintervention was 97.9, 98.6, and 97.8%, respectively. There was a decrease in the left ventricular (LV) end-diastolic volume index (60.1 mL/m² at baseline versus 55.4 mL/m² at 3 years) and the LV mass index (128.5 g/m² versus 102.7 g/m²); LV ejection fraction increased from 57.6% at baseline to 59.4% at 3 years. In terms of hemodynamic performance, mean aortic valve gradient was 42.7 mm Hg at baseline, decreasing to 11.9 mm Hg at 3-year follow-up, while baseline indexed effective orifice area and Doppler velocity index increased from 0.5 cm² to 0.8 cm² and 0.3 to 0.5, respectively. NYHA functional class improved, with 41.2% in class III or IV at baseline and 5.7% at 3 years. Mild transprosthetic regurgitation at 3 years was reported in 4.5% of patients. Paravalvular leak was none/trace in 98.0% and mild in 2.0%.

Conclusion: At 3-year follow-up, SAVR using bioprosthetic aortic valve was associated with favorable survival and improved hemodynamic and functional status in a young population of patients.

Publikationsverlauf

Artikel online veröffentlicht:
11. Februar 2025