Abstract 13920: Short and Long-Term Outcomes and Predictors of Mortality of Aortic Valve Surgery in Patients with Acute Decompensated Aortic Valve Disease
Objective Urgent and emergent aortic valve (AV) surgery performed for acute decompensated AV disease is associated with poor outcomes. We analysed our experience with this cohort of patients to determine the 30-day and long-term mortality and independent predictors for the same.
Methods Patients with AV disease with clinical manifestations ranging from dyspnoea or tachycardia with pulmonary congestion to pulmonary edema or cardiogenic shock were considered to have acute decompensated AV disease. Demographic, intraoperative and outcome data of these patients undergoing primary or redo AV surgery at our institution from April 1995 to June 2010 were prospectively collected. Aortic dissections were excluded. Multivariate logistic regression and Cox regression analyses identified the predictors of 30-day and long-term mortality, respectively.
Results Of 599 patients with acute decompensated AV disease, 21.5% underwent urgent and 78.5% emergent AV surgery. Mean age was 64.6±13 years. On admission to the hospital, 83% patients were in NYHA class III or IV and 16.5% were in cardiogenic shock. A fourth of the patients required inotropes, 10% needed intubation and 7% required cardiopulmonary resuscitation before surgery. Overall 30-day mortality was 15.7%. It was independently predicted by preoperative NYHA class (Odds Ratio [OR]: 1.2; 95%CI: 0.7 - 1.9), inotrope use (OR: 1.8; 95%CI: 1.1 - 3.1), cardiogenic shock (OR: 2.1; 95%CI: 1.2 - 3.7), cardiopulmonary resuscitation (CPR) (OR: 3.4; 95%CI: 1.6 - 7.4), previous cardiac surgery (OR: 1.8; 95%CI: 1 - 3.2), coronary artery disease (OR: 1.4; 95%CI: 0.7 - 2.6) and dialysis (OR: 3.7; 95%CI: 1.2 - 11.4). In addition to the first four predictors, Cox regression analysis also found COPD, poor LVEF, active endocarditis and peripheral vascular disease to be independent predictors of long-term mortality. Mean survival at 5 and 10 years was 56±2% and 38±4%, respectively.
Conclusions AV surgery can be performed with acceptable 30-day mortality in patients with acute decompensated AV disease, considering the highly selected group of patients with severely compromised hemodynamic stability. Preoperative inotrope use, cardiogenic shock, CPR, and previous cardiac surgery predict both 30-day and long-term mortality.
- © 2011 by American Heart Association, Inc.