Abstract 13250: Metabolic Syndrome and Postoperative Outcomes After Heart Valve Surgery
Background: We have previously shown that Metabolic Syndrome (MetS) negatively affects outcomes after coronary artery bypass grafting (CABG). Recently, synergic effects leading to a pro-thrombotic state has been demonstrated in the contest of MetS, which has been implicated in both accelerated native aortic valve stenosis and progression of bioprosthetic valve degeneration. Aim of the present study was to assess the impact of MetS on postoperative outcomes of patients undergoing heart valve surgery.
Methods and Results: A consecutive series of 749 patients undergoing elective first-time heart valve surgery at one Institution was studied. Metabolic syndrome was diagnosed using the modified Adult Treatment Panel III of National Cholesterol Education Program criteria. A total of 307/749 (40.9%) patients showed MetS at baseline. Major adverse cardiovascular events (MACE; including death, myocardial infarction, cerebrovascular accident, prosthetic dysfunction, and need for re-operation) were investigated. At a mean follow-up of 37±16 months, mortality was 19/307 (6.2%) vs. 17/442 (3.8%) in patients with and without MetS, respectively (p=0.04). At three years, freedom from MACE was significantly poorer among patients with MetS (47±6% vs. 59±8% of those without MetS) showing statistical significance (χ2 3.82; HR 2.04; 95% CI 1.56 to 4.13). Of note, the occurrence of every single component of the composite outcome “MACE” was significantly increased among MetS patients; particularly, freedom from prosthetic valve dysfunction (because of thrombosis, endocarditis or paravalvular leak) was 82±4% in the MetS subgroup vs. 91±3% for patients without MetS (χ2 4.03; HR 1.85; 95% CI 1.51 to 2.79).
Conclusions: MetS is associated with poorer outcomes after heart valve surgery. Given its modifiable nature, MetS should be recognized as a independent preoperative variable to identify high-risk patients and, moreover, should be corrected with lifestyle modifications and pharmacologic therapy to improve the results of valvular surgery.
- © 2013 by American Heart Association, Inc.