Numerous reports relate continuous improvement of inhospital outcome after aortic valve replacement (AVR). Less data are available on the changes of preoperative risk profile and on the long-term outcome.

To assess the temporal changes on preoperative risk, short and long-term outcomes, the data of a consecutive series of 2218 procedures of AVR analyzed in a single center during a 20-year period (1993–2013) were performed.

Bioprotheses (B) were used in 1326 cases, mechanical (M) valves in 892 cases. Mean age was 71±10 y (B: 76±6 y; M: 63±10 y.). Inhospital mortality was 6.4% (B: 7.8%; M: 4.4%). The inclusion period was divided in 4 periods of 5 y. Both Euroscores were strictly calculated according to the published criteria. Data are presented here according to early period versus the latest period.

Preoperative risk was 8.1±7.2 vs. 9.1±8.4 (NS) according to the log Euroscore and 4.9±5.5 vs. 4.2±5.0 (P<0.01) according to Euroscore 2010. Inhospital mortality decreased from 7.1% to 4.8% (NS). Overall survival (according to national population statistics) at 1,5 and 10 y were respectively 89.3%; 73.1% and 47.3%. 1-y survival increased from 87.1% to 90.7% (P<0.05). 5-y survival was unchanged (70.6% vs. 71.4%) (NS). According a MV analysis (log regression) the following variables were associated with poor outcome (death during follow-up): bioprothesis (OR: 1.52), age (OR: 1.05), COPD (OR 1.93), diabetes (OR: 1.52), NYHA class (OR: 1.24); LV dysfunction (OR: 1.13), log Euroscore (OR: 1.02), extracorporeal circulation time (OR: 1.01). No relationship was found between the inclusion period and long term outcome.

Despite a trend of improved of inhospital and 1-y outcome after aortic valve replacement, the long-term outcome has not improved over time. In our experience, AVR by a mechanical prosthesis was associated with better long-term outcome.