PT  - JOURNAL ARTICLE
AU  - Bart J J Velders
AU  - Michiel D Vriesendorp
AU  - Rob A F De Lind Van Wijngaarden
AU  - Vivek Rao
AU  - Michael J Reardon
AU  - Malakh Shrestha
AU  - Michael W A Chu
AU  - Joseph F Sabik III
AU  - Fang Liu
AU  - Robert J M Klautz
TI  - Perioperative care differences of surgical aortic valve replacement between North America and Europe
AID  - 10.1136/heartjnl-2023-322350
DP  - 2023 Jul 01
TA  - Heart
PG  - 1106--1112
VI  - 109
IP  - 14
4099  - http://heart.bmj.com/content/109/14/1106.short
4100  - http://heart.bmj.com/content/109/14/1106.full
SO  - Heart2023 Jul 01; 109
AB  - Objective To describe differences between North America and Europe in the perioperative management of patients undergoing surgical aortic valve replacement (SAVR).Methods Patients with moderate or greater aortic stenosis or regurgitation requiring SAVR were enrolled in a prospective observational cohort evaluating the safety and efficacy of a new stented bioprosthesis at 25 centres in North America (Canada and the USA) and 13 centres in Europe (Germany, the Netherlands, France, the UK, Switzerland and Italy). While all patients underwent implantation with the same bioprosthetic model, perioperative management was left to the discretion of participating centres. Perioperative care was described in detail including outcomes up to 1-year follow-up.Results Among 1118 patients, 643 (58%) were implanted in North America, and 475 (42%) were implanted in Europe. Patients in Europe were older, had a lower body mass index, less bicuspid disease and worse degree of aortic stenosis at baseline. In Europe, anticoagulant therapy at discharge was more aggressive, whereas length of stay was longer, and discharges directly to home were less common. Rehospitalisation risk was lower in Europe at 30 days (8.5% vs 15.9%) but converged at 1-year follow-up (26.5% vs 28.1%). Within continents, there were major differences between individual countries concerning perioperative management.Conclusion Contemporary perioperative management of SAVR patients varies between North America and Europe in patient selection, procedural techniques, antithrombotic regimen and discharge management. Furthermore, rehospitalisation differed largely between continents and countries. Hence, geographical setting must be considered during design and interpretation of trials on SAVR.Trial registration number NCT02088554.Data may be obtained from a third party and are not publicly available.The data underlying this article were provided by the sponsor and will not be shared with third parties for purposes of reproducing the results.