Abstract 1807: Comparison of Aortic Valve Replacement and Composite Aortic Valve Graft Replacement: Mortality Outcomes in a National Registry
Introduction: Composite aortic valve and graft replacement (CAVG) is a more complex procedure than isolated aortic valve replacement (AVR). Using a national database we examined 30-day, 1 and 5 years survival for both procedures.
Methods: The United Kingdom Heart Valve Registry was interrogated for 80791 first-time AVR and 2006 CAVG procedures (ratio 40:1) from 1986 to 2005. Follow-up survival data was 98% complete. Potential risk factors available on the database were examined.
Results: Overall thirty-day mortality was 4.5% and 10.4% for AVR and CAVG respectively (p<0.001). Survival at 1 and 5 years was 91.4% [CI: 91.2–91.6] and 80.2% [CI: 79.9 – 80.5] for AVR and 85.1% [CI: 83.5– 86.6] and 77.2% [CI: 75.1–79.1] for CAVG. Early mortality for elective AVR and CAVG was 3.4% and 5.2% (p<0.005) respectively. For elective group, 1 and 5 year survival was 92.9% [CI: 92.6–93.1] and 81.8% [CI: 81.3– 82.3] for AVR and 91.5% [CI: 89.5–93.2] and 82.7% [CI: 79.8 – 85.3] for CAVG. Both procedures carried incremental mortality risk according to urgency - AVR urgent 6.4%, emergency 16% (p< 0.001), CVG urgent 11.7% emergency 27.2% (p< 0.001). Significant risk factors (univariate analysis) for overall 30-day mortality (CAVG versus AVR) were identified as female gender, operative priority, age greater than 50 years, degenerative and mixed degenerative/congenital valve disease, valve size equal to or less than 23 mm(OR 2.39 [CI 1.6 –3.8]), hospital activity volume equal to or less than 40 per annum(OR 1.5 [CI 1.1–2.O], renal failure, previous cardiac surgery(OR 4.6 [CI 2.8 –7.8]) and hypertension. Female gender and hospital activity were no longer considered significant in the multivariate analysis.
Conclusions: These data provide unique national survival data for CAVG versus AVR. Elective medium term survival is similar, but CAVG carries a higher initial risk. Early mortality post-CAVG is related to similar risk factors to AVR, but includes previous cardiac surgery, small prosthetic size and volume of activity.