Surgical aortic valve replacement in Australia, 2002–2015: temporal changes in clinical practice, patient profiles and outcomes

Background: This study describes the temporal changes in risk profiles and outcomes among patients with aortic stenosis (AS) undergoing surgical aortic valve replacement (SAVR) in Australia between 2002 and 2015. Methods: Using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons database, we identified first-recorded SAVR for AS over 14 years. Patients’ surgical risk profiles, procedures, 30-day and 12-month outcomes were summarized before and after the introduction of transcatheter aortic valve implantation in Australia, in 2008. We applied multivariable regression models to investigate the changes over time on risk-adjusted 30-day mortality, re-hospitalization and 12-month mortality. Results: We identify a total of 18 147 patients with AS who underwent SAVR; mostly men (64%) with a mean age of 72 years. The proportion of major cardiac surgeries devoted to SAVR increased from 14% in 2002 to 20% in 2015. More SAVRs were performed electively (80% in 2002 versus 86% in 2015), and the recipients were at lower surgical risk (mean multi-risk score 3.9% in 2002 versus 3.0% in 2015). The use of bioprosthetic aortic valves increased over time (67% in 2002 to 88% in 2015). We found no significant changes in 30-day mortality, a significant decrease in 30-day readmission and minor fluctuations in 12-month mortality over the study period. Conclusion: SAVR comprises an increasingly larger proportion of all adult cardiac surgeries in Australia. There has been a greater use of bioprosthetic aortic valves, a fall in 30-day readmission but no significant changes in mortality.