Christopher T Ryan1, Ayman Almousa1, Rodrigo Zea-Vera1, Qianzi Zhang2, Christopher I Amos3, Joseph S Coselli4, Todd K Rosengart4, Ravi K Ghanta5. 1. Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas. 2. Biostatistics, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas. 3. The Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas. 4. Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas. 5. Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas. Electronic address: ravi.ghanta@bcm.edu.
Abstract
BACKGROUND: This study evaluated outcomes and risk factors for surgical aortic valve replacement (SAVR) for aortic insufficiency (AI) in a national cohort. We analyzed the incidence, outcomes, and risk factors for SAVR for AI in the Society of Thoracic Surgeons Adult Cardiac Surgery Database. METHODS: The national database was queried for patients with moderate or greater AI undergoing isolated SAVR between July 2011 and December 2018. Patients with moderate or greater aortic stenosis, acute dissection, active endocarditis, concomitant procedures, or emergent operation were excluded. AI was staged using guideline criteria based on symptoms and ventricular remodeling. Operative mortality and morbidity were compared between stages, and risk factors for operative death were identified. RESULTS: A total of 12,564 patients underwent isolated SAVR for AI from 2011 to 2018. Patients were most frequently AI stage D (7019 [57.5%]), compared with B (1405 [11.2%]), C1 (1128 [9.0%]), or C2 (1325 [10.5%]). Operative mortality was 1.1% overall, and increased between stage C1, C2, and D (0.4% vs 0.7% vs 1.6%, respectively, P < .01), along with major morbidity (5.1% vs 7.5% vs 9.9%, respectively; P < .01). Mortality was higher in patients with severe ventricular dilation and an ejection fraction of less than 0.30 (2.7% vs 1.0%, P < .01). Risk factors for death were symptomatic AI, decreased ejection fraction, age, weight, body surface area, and dialysis. CONCLUSIONS: Operative mortality and morbidity for isolated SAVR for AI is very low in a national cohort, providing a benchmark for future transcatheter approaches. Operative risk increases with advanced ventricular remodeling. SAVR before development of ventricular remodeling may be appropriate in patients with severe AI.
BACKGROUND: This study evaluated outcomes and risk factors for surgical aortic valve replacement (SAVR) for aortic insufficiency (AI) in a national cohort. We analyzed the incidence, outcomes, and risk factors for SAVR for AI in the Society of Thoracic Surgeons Adult Cardiac Surgery Database. METHODS: The national database was queried for patients with moderate or greater AI undergoing isolated SAVR between July 2011 and December 2018. Patients with moderate or greater aortic stenosis, acute dissection, active endocarditis, concomitant procedures, or emergent operation were excluded. AI was staged using guideline criteria based on symptoms and ventricular remodeling. Operative mortality and morbidity were compared between stages, and risk factors for operative death were identified. RESULTS: A total of 12,564 patients underwent isolated SAVR for AI from 2011 to 2018. Patients were most frequently AI stage D (7019 [57.5%]), compared with B (1405 [11.2%]), C1 (1128 [9.0%]), or C2 (1325 [10.5%]). Operative mortality was 1.1% overall, and increased between stage C1, C2, and D (0.4% vs 0.7% vs 1.6%, respectively, P < .01), along with major morbidity (5.1% vs 7.5% vs 9.9%, respectively; P < .01). Mortality was higher in patients with severe ventricular dilation and an ejection fraction of less than 0.30 (2.7% vs 1.0%, P < .01). Risk factors for death were symptomatic AI, decreased ejection fraction, age, weight, body surface area, and dialysis. CONCLUSIONS: Operative mortality and morbidity for isolated SAVR for AI is very low in a national cohort, providing a benchmark for future transcatheter approaches. Operative risk increases with advanced ventricular remodeling. SAVR before development of ventricular remodeling may be appropriate in patients with severe AI.
Authors: Joe K T Lee; Anna Franzone; Jonas Lanz; George C M Siontis; Stefan Stortecky; Christoph Gräni; Eva Roost; Stephan Windecker; Thomas Pilgrim Journal: Circulation Date: 2018-01-09 Impact factor: 29.690
Authors: Vinay Badhwar; J Scott Rankin; Vinod H Thourani; Richard S D'Agostino; Robert H Habib; David M Shahian; Jeffrey P Jacobs Journal: Ann Thorac Surg Date: 2018-07 Impact factor: 4.330
Authors: Amgad Mentias; Ke Feng; Alaa Alashi; L Leonardo Rodriguez; A Marc Gillinov; Douglas R Johnston; Joseph F Sabik; Lars G Svensson; Richard A Grimm; Brian P Griffin; Milind Y Desai Journal: J Am Coll Cardiol Date: 2016-11-15 Impact factor: 24.094
Authors: Amy G Fiedler; Vijeta Bhambhani; Elizabeth Laikhter; Michael H Picard; Meagan M Wasfy; George Tolis; Serguei Melnitchouk; Thoralf M Sundt; Jason H Wasfy Journal: Heart Date: 2017-11-01 Impact factor: 5.994
Authors: Delphine Detaint; David Messika-Zeitoun; Joseph Maalouf; Christophe Tribouilloy; Douglas W Mahoney; A Jamil Tajik; Maurice Enriquez-Sarano Journal: JACC Cardiovasc Imaging Date: 2008-01
Authors: Sunil K Bhudia; Patrick M McCarthy; Ganesh S Kumpati; Joe Helou; Katherine J Hoercher; Jeevanantham Rajeswaran; Eugene H Blackstone Journal: J Am Coll Cardiol Date: 2007-03-21 Impact factor: 24.094
Authors: Jacqueline T DesJardin; Joanna Chikwe; Rebecca T Hahn; Judy W Hung; Francesca N Delling Journal: Circ Res Date: 2022-02-17 Impact factor: 17.367