A multi-centre additive and logistic risk model for in-hospital mortality following aortic valve replacement

Objective: To create a risk model to assess outcomes of aortic valve replacement after cardiovascular surgery (ReAVR) using a national Japanese database. Methods: The Japan Adult Cardiovascular Surgery Database is a web-based data system involving more than 500 hospitals. Between 2007 and 2012, 2,227 patients who underwent ReAVR for aortic stenosis were retrospectively analyzed. Patients with a previous history of AVR were also included. Results: The background of prior surgery (including overlapping cases) was: CABG, 30.9%; valve, 65.4%; and thoracic aorta, 14.7%. The mean age was 70.4. Types of prosthesis used were: bioprosthesis, 51.3%; and mechanical valve, 48.7%. The rate of isolated ReAVR was 59.5%. Concomitant procedures were: CABG, 14.6%; mitral valve surgery, 30.4%; and aortic surgery, 5.7%. The overall hospital mortality rate was 8.7%. Major complications (reoperation, prolonged ventilation, mediastinitis, stroke, and newly required dialysis) occurred in 26.0%. The incidence of stroke was 3.7%, and that of AV block was 3.5%. ORs for hospital mortality were as follows: age, 1.4 (reference ≦60, 5-year increments); male, 1.4; urgency, 1.7; EF ≦30%, 2.0; NYHA classification IV, 1.7; MR ≧2, 1.5; creatinine >2.0 mg/dL, 2.7; liver dysfunction (cirrhosis, AST or ALT >100 U/L, or bilirubin >1.5 mg/dL), 2.3; peripheral artery disease, 1.6; and recent stroke (<2 weeks), 4.8. The type of previous surgery was not a predictor for mortality. In addition to the above-mentioned risk factors, ORs for the composite outcome (mortality and major complications) were as follows: carotid stenosis, 2.5; respiratory dysfunction (FEV1.0 <75%, or bronchodilator use), 1.8; prior valve surgery, 1.3; preoperative inotropic agents, 2.0; endocarditis, 1.7; concomitant CABG, 1.4; and concomitant valve surgery, 1.5. As a performance metric model, C-indexes of hospital mortality and the composite outcome were 0.77 and 0.71, respectively. Conclusions: Based on a national Japanese database, early outcomes after ReAVR were satisfactory, despite these operations being associated with a higher risk than the primary operations. The type of previous surgery was not a risk for mortality after ReAVR.

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Use and outcomes of emergency treatment strategies in patients with aortic valve stenosis

European Heart Journal ◽

10.1093/ehjci/ehaa946.2598 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S.M Piepenburg ◽

K Kaier ◽

C Olivier ◽

M Zehender ◽

C Bode ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Mortality ◽

Valve Replacement ◽

Aortic Valve Stenosis ◽

Emergency Treatment ◽

Funding Source ◽

Artery Disease

Abstract Introduction and aim Current emergency treatment options for severe aortic valve stenosis include surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) and balloon valvuloplasty (BV). So far no larger patient population has been evaluated regarding clinical characteristics and outcomes. Therefore we aimed to describe the use and outcome of the three therapy options in a broad registry study. Method and results Using German nationwide electronic health records, we evaluated emergency admissions of symptomatic patients with severe aortic valve stenosis between 2014 and 2017. Patients were grouped according to SAVR, TAVR or BV only treatments. Primary outcome was in-hospital mortality. Secondary outcomes were stroke, acute kidney injury, periprocedural pacemaker implantation, delirium and prolonged mechanical ventilation >48 hours. Stepwise multivariable logistic regression analyses including baseline characteristics were performed to assess outcome risks. 8,651 patients with emergency admission for severe aortic valve stenosis were identified. The median age was 79 years and comorbidities included NYHA classes III-IV (52%), coronary artery disease (50%), atrial fibrillation (41%) and diabetes mellitus (33%). Overall in-hospital mortality was 6.2% during a mean length of stay of 22±15 days. TAVR was the most common treatment (6,357 [73.5%]), followed by SAVR (1,557 [18%]) and BV (737 8.5%]). Patients who were treated with TAVR or BV were significantly older than patients with SAVR (mean age 81.3±6.5 and 81.2±6.9 versus 67.2±11.0 years, p<0.001), had more relevant comorbidities (coronary artery disease 52–91% vs. 21.8%; p<0.001), worse NYHA classes III-IV (55–65% vs. 34.5%; p<0.001) and higher EuroSCORES (24.6±14.3 and 23.4±13.9 vs. 9.5±7.6; p<0.001) than SAVR patients. Patients treated with BV only had the highest in-hospital mortality compared with TAVR or SAVR (20.9% vs. 5.1 and 3.5%; p<0.001). Compared with BV only, SAVR patients (adjusted odds ratio [aOR] 0.25; 95% confidence interval [CI] 0.14–0.46; p<0.001) and TAVR patients (aOR 0.37; 95% CI 0.28–0.50; p<0.001) had a lower risk for in-hospital mortality. Conclusion In-hospital mortality for emergency patients with symptomatic severe aortic valve stenosis is high. Our results showed that BV only therapy was associated with highest mortality, which is in line with current research. Yet, there is a trend towards more TAVR interventions and this study might imply that balloon valvuloplasty alone is insufficient. The role of BV as a bridging strategy to TAVR or SAVR needs to be further investigated. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany

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Development and In-Hospital Mortality of Transcatheter and Surgical Aortic Valve Replacement in 2015 in Germany

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.04.077 ◽

2018 ◽

Vol 72 (4) ◽

pp. 475-476 ◽

Cited By ~ 6

Author(s):

Peter Stachon ◽

Manfred Zehender ◽

Christoph Bode ◽

Constantin von zur Mühlen ◽

Klaus Kaier

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Mortality ◽

Valve Replacement ◽

Surgical Aortic Valve Replacement

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Bleeding Complications Drive In-Hospital Mortality of Patients with Atrial Fibrillation after Transcatheter Aortic Valve Replacement

Thrombosis and Haemostasis ◽

10.1055/s-0040-1715833 ◽

2020 ◽

Vol 120 (11) ◽

pp. 1580-1586 ◽

Cited By ~ 1

Author(s):

Achim Lother ◽

Klaus Kaier ◽

Ingo Ahrens ◽

Wolfgang Bothe ◽

Dennis Wolf ◽

...

Keyword(s):

Atrial Fibrillation ◽

Risk Factor ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Mortality ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Bleeding Complications ◽

Hospital Outcome ◽

Transcatheter Aortic Valve

Abstract Background Atrial fibrillation (AF) is a risk factor for poor postoperative outcome after transfemoral transcatheter aortic valve replacement (TF-TAVR). The present study analyses the outcomes after TF-TAVR in patients with or without AF and identifies independent predictors for in-hospital mortality in clinical practice. Methods and Results Among all 57,050 patients undergoing isolated TF-TAVR between 2008 and 2016 in Germany, 44.2% of patients (n = 25,309) had AF. Patients with AF were at higher risk for unfavorable in-hospital outcome after TAVR. Including all baseline characteristics for a risk-adjusted comparison, AF was an independent risk factor for in-hospital mortality after TAVR. Among patients with AF, EuroSCORE, New York Heart Association classification class, or renal disease had only moderate effects on mortality, while the occurrence of postprocedural stroke or moderate to major bleeding substantially increased in-hospital mortality (odds ratio [OR] 3.35, 95% confidence interval [CI] 2.61–4.30, p < 0.001 and OR 3.12, 95% CI 2.68–3.62, p < 0.001). However, the strongest independent predictor for in-hospital mortality among patients with AF was severe bleeding (OR 18.00, 95% CI 15.22–21.30, p < 0.001). Conclusion The present study demonstrates that the incidence of bleeding defines the in-hospital outcome of patients with AF after TF-TAVR. Thus, the periprocedural phase demands particular care in bleeding prevention.

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Temporal Trends and Outcomes of Percutaneous and Surgical Aortic Valve Replacement in Patients With Atrial Fibrillation

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2020.603834 ◽

2020 ◽

Vol 7 ◽

Author(s):

Jing Wu ◽

Chenguang Li ◽

Yang Zheng ◽

Qian Tong ◽

Quan Liu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Hospital Mortality ◽

Valve Replacement ◽

Severe Aortic Stenosis ◽

Temporal Trends ◽

Surgical Aortic Valve Replacement ◽

Hospital Outcomes

Objectives: The aim of this study was to evaluate the temporal trends of transcatheter aortic valve replacement (TAVR) in severe aortic stenosis (AS) patients with atrial fibrillation (AF) and to compare the in-hospital outcomes between TAVR and surgical aortic valve replacement (SAVR) in patients with AF.Background: Data comparing TAVR to SAVR in severe AS patients with AF are lacking.Methods: National inpatient sample database in the United States from 2012 to 2016 were queried to identify hospitalizations for severe aortic stenosis patients with AF who underwent isolated aortic valve replacement. A propensity score-matched analysis was used to compare in-hospital outcomes for TAVR vs. SAVR for AS patients with AF.Results: The analysis included 278,455 hospitalizations, of which 124,910 (44.9%) were comorbid with AF. Before matching, TAVR had higher in-hospital mortality than SAVR (3.1 vs. 2.2%, p < 0.001); however, there was a declining trend during the study period (Ptrend < 0.001). After matching, TAVR and SAVR had similar in-hospital mortality (2.9 vs. 2.9%, p < 0.001) and stroke. TAVR was associated with lower rates of acute kidney injury, new dialysis, cardiac complications, acquired pneumonia, sepsis, mechanical ventilation, tracheostomy, non-routine discharge, and shorter length of stay; however, TAVR was associated with more pacemaker implantation and higher cost. Of the patients receiving TAVR, the presence of AF was associated with an increased rate of complications and increased medical resource usage compared to those without AF.Conclusions: In-hospital mortality and stroke for TAVR and SAVR in AF, AS are similar; however, the in-hospital mortality in TAVR AF is declining and associated with more favorable in-hospital outcomes.

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