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Introduction: Aortic valve pathology carries a high mortality burden. Its incidence is growing in proportion to the continuous ageing of the population. Surgery remains the gold standard in the treatment of severe aortic valve disease. Methods: We performed a retrospective analysis of the University Hospital Center Zagreb’s cardiac surgical database from 2009 to 2020, focusing on surgical aortic valve replacement (SAVR). We dichotomized patients with respect to the date of their surgical procedures into two eras. Group 1 included patients operated from 2009-2014, whereas Group 2 included patients operated on from 2015-2020. Results: A total of 1012 SAVRs were identified during the study period. The procedural volume over the two identical 6-year time periods increased in the latter era from 413 to 598. When comparing groups 1 and 2, we have observed in increase in the number of patients with diabetes (19% vs. 26%, P=0.015) and coronary artery disease (14% vs. 18%, P=0.099). The composite risk assessment score increased significantly from 3.0±2.4 to 3.2±2.7, P=0.023. Despite an increase in the comorbidity burden of the targeted patient population, the periprocedural mortality remained the same (2.1% vs 2.5%, P=0.835). The per-patient averaged volume of transfused packed red blood cells decreased from 839±954 to 614±821 ml, P<0.001. An increase in the proportion of tissue valve implantations in comparison to mechanical prostheses was also noted in the present era (58% vs 68%, P=0.001) Conclusion: Despite an increasingly more complex patient population referred for SAVR in the contemporary era, the results have remained excellent. The introduction of transcatheter methods should measure up to the surgical standard. [ABSTRACT FROM AUTHOR]

Aim To evaluate the impact of minimally invasive aortic valve replacement (mini-AVR) on clinical outcomes in comparison with the gold standard. Methods We retrospectively reviewed the records of all patients who underwent isolated AVR at the University Hospital Center Zagreb from 2010 to 2020. Patients undergoing mini-AVR were compared with patients undergoing conventional AVR (fs-AVR). The primary outcome measure was blood product consumption. Propensity score matching was used to create a balanced covariate distribution across treatment groups. Additionally, we compared the contemporary outcomes with a historical control. Results The final sample consisted of 1088 patients. In the unmatched cohorts, mini-AVR patients were younger (65 ± 12 vs 68 ± 10 years, P < 0.001) and had lower risk profiles (EuroSCORE2 2.8 ± 2.0 vs 3.5 ± 3.1, P = 0.003). After matching, mini-AVR patients required less blood transfusion than fs-AVR patients (270 [0-790] vs 510 [0-970] mL, P = 0.029). The incidences of stroke, dialysis, new AV block, and mortality were comparable. Cross-clamp times were longer in the mini-AVR group (71 [60-87] vs 66 [53-83] minutes, P = 0.013). Outcomes were improved in the contemporary mini-AVR era compared with our early mini-AVR experience across multiple metrics. Blood product consumption was reduced in the latter tercile of experience (0 [0-520] vs 500 [0-1018] mL, P < 0.001), and the operation was performed more expeditiously (cross-clamp times: 63 [54,80] vs 74 [62,88] minutes, P < 0.001) in comparison with earlier periods. Conclusions We showed that mini-AVR was associated with less blood product requirement than conventional surgery. Our data supports wider adoption of minimally invasive techniques in dedicated centers of excellence. [ABSTRACT FROM AUTHOR]