Outcomes of surgical aortic valve replacement in high-risk patients: A multiinstitutional study

Vinod H. Thourani, Gorav Ailawadi, Wilson Y. Szeto, Todd M. Dewey, Robert A. Guyton, Michael J. MacK, Irving L. Kron, Patrick Kilgo, Joseph E. Bavaria

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)49-56
Number of pages8
JournalAnnals of Thoracic Surgery
Volume91
Issue number1
DOIs
StatePublished - Jan 1 2011
Externally publishedYes

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Aortic Valve
Surgical Instruments
Hospital Mortality
Stroke
Benchmarking
Heart Block
Survival
Peripheral Vascular Diseases
Mortality
Coronary Artery Bypass
Renal Insufficiency
Dialysis
Length of Stay
Pneumonia
Heart Failure

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Thourani, V. H., Ailawadi, G., Szeto, W. Y., Dewey, T. M., Guyton, R. A., MacK, M. J., ... Bavaria, J. E. (2011). Outcomes of surgical aortic valve replacement in high-risk patients: A multiinstitutional study. Annals of Thoracic Surgery, 91(1), 49-56. https://doi.org/10.1016/j.athoracsur.2010.09.040

Outcomes of surgical aortic valve replacement in high-risk patients : A multiinstitutional study. / Thourani, Vinod H.; Ailawadi, Gorav; Szeto, Wilson Y.; Dewey, Todd M.; Guyton, Robert A.; MacK, Michael J.; Kron, Irving L.; Kilgo, Patrick; Bavaria, Joseph E.

In: Annals of Thoracic Surgery, Vol. 91, No. 1, 01.01.2011, p. 49-56.

Research output: Contribution to journalArticle

Thourani, VH, Ailawadi, G, Szeto, WY, Dewey, TM, Guyton, RA, MacK, MJ, Kron, IL, Kilgo, P & Bavaria, JE 2011, 'Outcomes of surgical aortic valve replacement in high-risk patients: A multiinstitutional study', Annals of Thoracic Surgery, vol. 91, no. 1, pp. 49-56. https://doi.org/10.1016/j.athoracsur.2010.09.040
Thourani, Vinod H. ; Ailawadi, Gorav ; Szeto, Wilson Y. ; Dewey, Todd M. ; Guyton, Robert A. ; MacK, Michael J. ; Kron, Irving L. ; Kilgo, Patrick ; Bavaria, Joseph E. / Outcomes of surgical aortic valve replacement in high-risk patients : A multiinstitutional study. In: Annals of Thoracic Surgery. 2011 ; Vol. 91, No. 1. pp. 49-56.
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abstract = "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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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.

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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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