Predictors for 30-day mortality after aortic valve replacement : does it change over time?
Faculty of Medicine and Health Sciences
S.l. , 2014
Biennal Meeting of the Society of Heart Valve Disease, Venice, Italy, June, 24, 2013
University of Antwerp
Background and aim of the study Referral patterns for aortic valve replacement have changed over time. The current study explores if the predictors for 30-day mortality also have changed between 1986 and 2006. Materals and methods One-thousand files of patients who underwent aortic valve replacement were studied retrospectively. For four 5-year periods, twenty preoperative (non-cardiac, cardiac and valvular) and five perioperative factors were screened for their effect on 30-day mortality by an univariate chi-square analysis. To identify the independent predictors, the significant factors were entered in a multivariate logistic regression analysis. Results There were 530 males. The median age was 75(71-77) years and 610 patients also underwent CABG. Thirty-day mortality was 37/1000. Between 1986 and 1991 (mortality 6/80), only one independent predictor could be identified: age over 80 (p=0.043; Odds Ratio=11.8, 95% Confidence Interval=1.0-148.9). Between 1992 and 1996 (mortality 6/216) the only independent predictor was congestive heart failure (p=0.026; OR=6.7; 95%CI=1.3-36.4). Age over 80 showed a trend. Between 1997 and 2001 (mortality 12/345), the independent predictors were need for urgent surgery (p<0.001; OR=38.8; 95%CI=6.3-237.5), concomitant coronary artery bypass grafting (p=0.002; OR=2.4; 95%CI=2.4-48.1) and need for digitalis (p=0.015; OR=5.5; 95%CI=1.4-21.5). Between 2002 and 2006, (mortality 13/365), the independent predictors were chronic renal disease (p=0.009; OR=5.1; 95%CI=1.5-17.5), age over 80 (p=0.010; OR=5.4; 95%CI=1.5-19.4) and need for urgent surgery (p=0.025; OR=8.1; 95%CI=1.2-52.9). Conclusions The 30-day mortality rate does not change noteworthy throughout the 20- year time span. Age over 80 remains a predictor throughout and need for urgent surgery has emerged as a major predictor from 1997 on. This predictor is liable for change, by earlier referral. This could improve the postoperative results.