Abstract 16748: Predictors of Bioprosthetic Aortic Valve Failure: Results in 73,616 Patients from the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery National Database
Background: Bioprostheses are increasingly used for aortic valve replacement (AVR); however, their durability remains a concern. We sought to identify factors associated with early reoperation in contemporary practice.
Methods: We linked records from 73,616 patients ≥65 years who underwent bioprosthetic AVR between 2000 and 2006 within the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database with Medicare claims using a probabilistic match. The risk of reoperation over a mean 4 years follow-up was calculated, and patient characteristics associated with reoperation were identified using Cox Proportional Hazards models.
Results: Overall, the 1, 3, and 5 year incidences of reoperation for AVR were 0.30%, 0.63%, and 0.85%, respectively. Patient characteristics associated with reoperation included younger age (HR, 1.22; 95% CI, 1.03 to 1.45 for 5 year age decrement among 65–74 year olds), male sex (1.48; 1.16 to 1.87), black race (1.67; 1.11 to 2.52), increased BSA (2.01; 1.25 to 3.26 for 1.0 m2 increase), preoperative hemodialysis (2.90; 1.59 to 5.27), complete heart block (1.68; 1.03 to 2.73), and prior valve surgery (1.58; 1.02 to 2.45), while mitral dysfunction (0.61; 0.41 to 0.91), prior MI (0.74; 0.56 to 0.97), and concomitant CABG (0.78; 0.64 to 0.95) were associated with decreased reoperative rates. Reoperation was associated with a 13.6% 30-day mortality and 43.1% discharge to an assisted living facility.
Conclusions: Early reoperation following bioprosthetic AVR is uncommon, but is associated with considerable morbidity and mortality. Substantial variation in the likelihood of reoperation exists between patient subgroups and may help guide future valve selection.
- © 2010 by American Heart Association, Inc.