English Polski
Vol 19 (2024): Continuous Publishing
Original paper
Published online: 2023-11-08

open access

Page views 895
Article views/downloads 150
Get Citation

Connect on Social Media

Connect on Social Media

Predictive factors of short-term mortality after surgical aortic valve replacement: a 10-year tertiary care hospital experience

Magdalena Anna Misztal-Teodorczyk1, Radosław Zwoliński1, Dawid Teodorczyk1, Ewa Oszczygieł2, Jarosław Drożdż1, Katarzyna Piestrzeniewicz1
DOI: 10.5603/fc.96873

Abstract

Introduction. Aortic valve replacement (AVR) is a standard surgical procedure for symptomatic severe aortic stenosis (AS). This study aimed to identify predictors of short-term mortality after AVR. The pre-surgical risk stratification in patients with symptomatic severe AS may help decide on the most adequate treatment.

Material and methods. A retrospective, observational study included 1171 patients who underwent surgical AVR in a large tertiary medical centre over 10 years (2009–2019). The early mortality defined as the mortality within one month after surgery was analysed.

Results. The mean age of the study group was 64 (± 10) years. The most common aetiology of the aortic valve disease was a degenerative process (78.9%). The postoperative complication rate was 19.1% and the short-term mortality rate was 3.4%. An increased risk of short-term mortality after AVR was related to type 2 diabetes (6.1% vs. 2.6%; p = 0.006), chronic kidney disease (stage 3 to 5; 25% vs. 2.8%; p < 0.001), history of percutaneous coronary intervention (PCI) (8.2% vs. 3.1%; p = 0.045), active infective endocarditis (20.5% vs. 2.9%; p = 0.007), significant mitral (24% vs. 2.6%; p < 0.001) and tricuspid regurgitation (25.7% vs. 2.9%; p = 0.001), periprocedural complications (15.4% vs. 0.5%; p < 0.001), and emergency AVR (11.3% vs. 2.7%; p = 0.001). The independent predictors of short-term mortality identified by multivariate analysis were active infective endocarditis (odds ratio [OR]: 4.99; p = 0.045), duration of the surgical procedure (OR: 1.00; p = 0.018) and New York Heart Association (NYHA) class III–IV (OR: 1.97; p = 0.01).

Conclusions. Active infective endocarditis, duration of the surgical procedure and NYHA class III-IV are the independent predictors of short-term mortality after AVR and should be considered in deciding on the most adequate treatment.

Article available in PDF format

View PDF Download PDF file

References

  1. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003; 24(13): 1231–1243.
  2. Arora S, Misenheimer JA, Ramaraj R. Transcatheter aortic valve replacement: comprehensive review and present status. Tex Heart Inst J. 2017; 44(1): 29–38.
  3. Tjang YS, van Hees Y, Körfer R, et al. Predictors of mortality after aortic valve replacement. Eur J Cardiothorac Surg. 2007; 32(3): 469–474.
  4. Spadaccio C, Alkhamees K, Al-Attar N. Recent advances in aortic valve replacement. F1000Res. 2019; 8.
  5. Kvidal P, Bergström R, Malm T, et al. Observed and relative survival after aortic valve replacement. J Am Coll Cardiol. 2000; 35(3): 747–756.
  6. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2021; 43(7): 561–632.
  7. Swift SL, Puehler T, Misso K, et al. Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis: a systematic review and meta-analysis. BMJ Open. 2021; 11(12): e054222.
  8. Nashef SAM, Sharples LD, Roques F, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012; 41(4): 734–744.
  9. Shahian DM, He X, Jacobs JP, et al. The Society of Thoracic Surgeons Isolated Aortic Valve Replacement (AVR) Composite Score: a report of the STS Quality Measurement Task Force. Ann Thorac Surg. 2012; 94(6): 2166–2171.
  10. Chen LW, Chen J, Zheng JN, et al. Prediction of short-term mortality after valve surgery: a single center's perspective. Chin Med J (Engl). 2018; 131(20): 2499–2502.
  11. Ibrahim KS, Kheirallah KA, Mayyas FA, et al. Predictors of short-term mortality after rheumatic heart valve surgery: A single-center retrospective study. Ann Med Surg (Lond). 2021; 62: 395–401.
  12. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012; 120(4): c179–c184.
  13. Edwards FH, Peterson ED, Coombs LP, et al. Prediction of operative mortality after valve replacement surgery. J Am Coll Cardiol. 2001; 37(3): 885–892.
  14. Yamauchi T, Takano H, Miyata H, et al. Risk factors for mortality and morbidity of surgical aortic valve replacement for aortic stenosis — risk model from a japan cardiovascular surgery database. Circ Rep. 2020; 1(3): 131–136.
  15. Toumpoulis IK, Chamogeorgakis TP, Angouras DC, et al. Independent predictors for early and long-term mortality after heart valve surgery. J Heart Valve Dis. 2008; 17(5): 548–556.
  16. Khan S, Dargham S, Al Suwaidi J, et al. Trends and outcomes of aortic valve replacement in patients with diabetes in the US. Front Cardiovasc Med. 2022; 9: 844068.
  17. Ram E, Kogan A, Levin S, et al. Type 2 diabetes mellitus increases long-term mortality risk after isolated surgical aortic valve replacement. Cardiovasc Diabetol. 2019; 18(1): 31.
  18. López-de-Andrés A, Perez-Farinos N, de Miguel-Díez J, et al. Impact of type 2 diabetes mellitus in the utilization and in-hospital outcomes of surgical aortic valve replacement in Spain (2001-2015). Cardiovasc Diabetol. 2018; 17(1): 135.
  19. Gardner SC, Grunwald GK, Rumsfeld JS, et al. Comparison of short-term mortality risk factors for valve replacement versus coronary artery bypass graft surgery. Ann Thorac Surg. 2004; 77(2): 549–556.
  20. Caceres Polo M, Thibault D, Thourani VH, et al. Risk analysis and outcomes of postoperative renal failure after aortic valve surgery in the United States. Ann Thorac Surg. 2020; 109(4): 1133–1141.
  21. Ruel M, Kapila V, Price J, et al. Natural history and predictors of outcome in patients with concomitant functional mitral regurgitation at the time of aortic valve replacement. Circulation. 2006; 114(1 Suppl): I541–I546.
  22. Bannay A, Hoen B, Duval X, et al. The impact of valve surgery on short- and long-term mortality in left-sided infective endocarditis: do differences in methodological approaches explain previous conflicting results? Eur Heart J. 2011; 32(16): 2003–2015.
  23. Wang TK, Ramanathan T, Choi DHM, et al. Preoperative atrial fibrillation predicts mortality and morbidity after aortic valve replacement. Interact Cardiovasc Thorac Surg. 2014; 19(2): 218–222.
  24. Blais C, Dumesnil JG, Baillot R, et al. Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement. Circulation. 2003; 108(8): 983–988.