TY - JOUR
T1 - Outcomes of surgical aortic valve replacement in high-risk patients
T2 - A multiinstitutional study
AU - Thourani, Vinod H.
AU - Ailawadi, Gorav
AU - Szeto, Wilson Y.
AU - Dewey, Todd M.
AU - Guyton, Robert A.
AU - MacK, Michael J.
AU - Kron, Irving L.
AU - Kilgo, Patrick
AU - Bavaria, Joseph E.
PY - 2011/1
Y1 - 2011/1
N2 - Background The introduction of transcatheter aortic valves has focused attention on outcomes after open aortic valve replacement (AVR) in very high-risk patients. This study analyzes the short-term and midterm outcomes of AVR in this patient cohort in the current surgical era. Methods A retrospective review was performed on 159 patients who underwent isolated, primary AVR with a STS PROM (Society of Thoracic Surgeons predicted risk of mortality) of 10% or greater from January 2002 to December 2007 at four US academic institutions. Patients with previous valve operations were excluded. A multivariable model was constructed to determine predictors of in-hospital mortality. Estimates of the cumulative event rate mortality were calculated by the Kaplan-Meier method. Results The mean age of all patients was 76.1 ± 11.2 years, most were men (92 of 159, 57.9%), and mean STS PROM was 16.3% ± 7.3%. Significant preoperative factors included the following: peripheral vascular disease, 33.3% (53 of 159); stroke, 23.3% (37 of 159); renal failure, 50.3% (80 of 159); New York Heart Association class III-IV heart failure, 78.0% (124 of 159); and previous coronary artery bypass grafting, 39.0% (62 of 159). Mean ejection fraction was 0.461 ± 0.153 and median implanted valve size was 23 mm. Postoperative complications included the following: stroke, 4.4% (7 of 159); heart block, 5.0% (8 of 159); multisystem organ failure, 6.9% (11 of 159); pneumonia, 7.5% (12 of 159); and dialysis, 8.2% (13 of 159). Postoperative length of stay was 12.6 ± 11.0 days and in-hospital mortality was 16.4% (26 of 159). One-, three-, and 5-year survival was 70.9%, 56.8%, and 47.4%, respectively. Conclusions In the current era, high-risk surgical patients undergoing open AVR have respectable short and mid-term survival. These results should serve as a benchmark for evaluating outcomes of transcatheter aortic valve implantation.
AB - Background The introduction of transcatheter aortic valves has focused attention on outcomes after open aortic valve replacement (AVR) in very high-risk patients. This study analyzes the short-term and midterm outcomes of AVR in this patient cohort in the current surgical era. Methods A retrospective review was performed on 159 patients who underwent isolated, primary AVR with a STS PROM (Society of Thoracic Surgeons predicted risk of mortality) of 10% or greater from January 2002 to December 2007 at four US academic institutions. Patients with previous valve operations were excluded. A multivariable model was constructed to determine predictors of in-hospital mortality. Estimates of the cumulative event rate mortality were calculated by the Kaplan-Meier method. Results The mean age of all patients was 76.1 ± 11.2 years, most were men (92 of 159, 57.9%), and mean STS PROM was 16.3% ± 7.3%. Significant preoperative factors included the following: peripheral vascular disease, 33.3% (53 of 159); stroke, 23.3% (37 of 159); renal failure, 50.3% (80 of 159); New York Heart Association class III-IV heart failure, 78.0% (124 of 159); and previous coronary artery bypass grafting, 39.0% (62 of 159). Mean ejection fraction was 0.461 ± 0.153 and median implanted valve size was 23 mm. Postoperative complications included the following: stroke, 4.4% (7 of 159); heart block, 5.0% (8 of 159); multisystem organ failure, 6.9% (11 of 159); pneumonia, 7.5% (12 of 159); and dialysis, 8.2% (13 of 159). Postoperative length of stay was 12.6 ± 11.0 days and in-hospital mortality was 16.4% (26 of 159). One-, three-, and 5-year survival was 70.9%, 56.8%, and 47.4%, respectively. Conclusions In the current era, high-risk surgical patients undergoing open AVR have respectable short and mid-term survival. These results should serve as a benchmark for evaluating outcomes of transcatheter aortic valve implantation.
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U2 - 10.1016/j.athoracsur.2010.09.040
DO - 10.1016/j.athoracsur.2010.09.040
M3 - Article
C2 - 21172485
AN - SCOPUS:78650493050
VL - 91
SP - 49
EP - 56
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 1
ER -