Prediction of Surgical Outcome after Aortic Valve Replacement

• Published in: Acta chirurgica belgica 2012-01, Vol.112 (1), p.59-64
• Main Authors: Mistiaen, W., Van Cauwelaerf, Ph, Muylaerf, Ph
• Format: Article
• Language: English
• Subjects: Arrhythmias, Cardiac - epidemiology; Biological and medical sciences; Female; General aspects; Heart Failure - epidemiology; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation - adverse effects; Humans; Logistic Models; Male; Medical sciences; Postoperative Complications - epidemiology; Risk Factors; Thromboembolism - epidemiology; Treatment Outcome
• ISSN: 0001-5458
• DOI: 10.1080/00015458.2012.11680796

Background : Aortic valve replacement has some major adverse outcomes. For these, the predictors need identification. Methods : This was a retrospective file study of 1000 consecutive patients who underwent AVR for degenerative aortic valve disease. Twenty-five preoperative and 5 peroperative factors were screened by a univariate Fisher-exact analysis. The predictors were identified in a second step by logistic regression multivariate analysis. Results : Five hundred thirty patients were male. The mean age was 75 (71-77) years and 610 also underwent CABG. For hospital mortality, need for urgent aortic valve replacement (p < 0.001) was the dominant predictor. Need for digitalis (p = 0.002) and age > 80 (p = 0.005) followed. For postoperative congestive heart failure, need for urgent aortic valve replacement was also dominant (p < 0.001). Atrial fibrillation (p = 0.001,) and ejection fraction < 50% (p = 0.055) were less important. For ventricular arrhythmia, previous infarction (p = 0.025) and ejection fraction < 50% (p = 0.032) were identified. For bleeding, concomitant CABG (p = 0.046) and chronic obstructive pulmonary disease were identified. For thromboembolic events only an ejection fraction < 50% (p = 0.027) was identified. Conclusions : Need for urgent aortic valve replacement is the dominant predictor for postoperative mortality and congestive heart failure. Once a degenerative aortic valve disease becomes symptomatic, prompt referral could prevent the development for need for urgent surgery, with all its adverse postoperative consequences.