Morbidity outcomes after surgical aortic valve replacement

Auensen, Andreas; Hussain, Amjad; Bendz, Bjørn; Aaberge, Lars; Falk, Ragnhild Sørum; Walle-Hansen, Marte Meyer; Bye, Jorun; Andreassen, Johanna; Beitnes, Jan Otto; Rein, Kjell Arne; Pettersen, Kjell I.; Gullestad, Lars

doi:10.1136/openhrt-2017-000588

Cited by 21 publications

(20 citation statements)

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“…The remaining 373 patients (80%) underwent either surgical aortic valve implantation (n=337) or transcatheter aortic valve implantation (TAVI) (n=36) at Oslo University Hospital, Rikshospitalet. The characteristics of patients who underwent AVR and those of conservatively treated patients have been reported previously showing that patients who underwent surgery were younger, had a higher NYHA and Canadian Cardiovascular Society class, had fewer comorbidities and used less medication 23…”

Section: Resultscontrasting

confidence: 79%

“…This study is part of a prospective cohort study on survival, morbidity, functional status and QoL in consecutive patients with severe AS referred for evaluation for AVR at Oslo University Hospital Rikshospitalet in Norway between May 2010 and March 2013 22 23. Inclusion criteria were age >18 years, severe AS and the ability to read and write in Norwegian.…”

Section: Methodsmentioning

confidence: 99%

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Prevalence and prognostic implication of iron deficiency and anaemia in patients with severe aortic stenosis

et al. 2018

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ObjectiveThe aim of this study was to evaluate the prevalence and prognostic implication of iron deficiency (ID) and anaemia in patients with severe aortic stenosis (AS).MethodsIn an observational study of consecutive patients referred for aortic valve replacement (AVR), we assessed a wide range of biomarkers of iron status, including the definition of ID commonly applied in patients with chronic heart failure (ferritin <100 µg/L or ferritin 100–299 µg/L with a transferrin saturation <20%). The endpoints were short-term (one-year) and long-term (median 4.7 years, IQR: 3.8–5.5) mortality and major adverse cardiovascular events (MACE) within the first year after inclusion.Results464 patients were included in this substudy. 91 patients (20%) received conservative treatment and 373 patients (80%) received AVR. ID was detected in 246 patients (53%). 94 patients (20%) had anaemia. Patients with ID had an overall worse clinical profile than patients without ID. During follow-up, 129 patients (28%) died. Neither ID as defined above, soluble transferrin receptor nor hepcidin were associated with short-term or long-term mortality or MACE independent on treatment allocation. Anaemia was associated with one-year mortality in conservatively treated patients.ConclusionsID and anaemia are prevalent in patients with severe AS. In our cohort, ID did not provide independent prognostic information on top of conventional risk factors. More studies are required to determine how to correctly diagnose ID in patients with AS.Trial registration numberNCT01794832.

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Section: Resultscontrasting

confidence: 79%

Section: Methodsmentioning

confidence: 99%

Prevalence and prognostic implication of iron deficiency and anaemia in patients with severe aortic stenosis

et al. 2018

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“…Limited data are currently available on detailed clinical events in patients with severe AS, especially among those who underwent SAVR 17. Our study elucidated the breakdown of cardiovascular events during the follow-up period less optimistically.…”

Section: Discussionmentioning

confidence: 83%

Propensity score-matched analysis of patients with severe aortic stenosis undergoing surgical aortic valve replacement

Maeda¹,

Yamashita²,

Hanyu

et al. 2019

Open Heart

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ObjectiveSevere aortic stenosis (AS) is one of the most serious valve conditions. Patient demography and the aetiology of AS have substantially changed in the past several decades along with a drastic improvement of surgical aortic valve replacement (SAVR) and its associated procedures. Contemporary patients with severe AS have multiple comorbidities and live much longer. We aimed to elucidate the treatment effects of SAVR on long-term outcome in propensity score (PS)-matched and the entire patient populations.MethodsWe retrospectively reviewed 570 patients with severe AS defined as an aortic valve area of 1.0 cm2 or less. Systemic differences in 39 baseline characteristics between non-SAVR and SAVR groups were adjusted using PS matching method. The endpoints included all-cause mortality and cardiovascular events that included heart failure, non-fatal stroke, syncope and acute coronary syndrome.ResultsOverall, 55% of the entire population (mean age 78 years; males 41%) were symptomatic. During 3.9 years of the median follow-up, 210 (36%) patients underwent SAVR and 231 (41%) died. Cumulative incidences of mortality and both mortality and cardiovascular events were significantly higher in the non-SAVR group than in the other group (p<0.001, each). Among 101 PS-matched pairs, SAVR correlated with a lower mortality risk (HR 0.35; 95% CI 0.21 to 0.59; p<0.001)) and mortality and cardiovascular events combined (HR 0.62; 95% CI 0.42 to 0.92; p=0.02). However, survival difference between both groups was markedly smaller among asymptomatic patients in the subgroup of matched patients.ConclusionPatients with AS undergoing SAVR exhibit a lower incidence of all-cause mortality and major cardiovascular events than those not undergoing surgical interventions, even after the baseline characteristics are balanced by the PS matching. The correlation between SAVR and survival from cardiovascular events is less evident among asymptomatic patients.

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“…The risks of undergoing surgical replacement of the aortic valve are not inconsiderable with a mortality of up to 5.6% (Kvidal et al, 2000 ), and a high morbidity burden (Auensen et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Relationship between endotoxin core, staphylococcal and varicella antibody levels and outcome following aortic valve replacement surgery: a prospective observational study

et al. 2018

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BackgroundMorbidity and mortality following cardiac valve surgery is high. Immunity is an important contributor to outcome. This study examines the relationship of staphylococcal and endotoxin antibody levels to outcome following cardiac surgery.MethodsUsing enzyme-linked immunosorbent assays (ELISA), we measured pre-operative levels of antibodies to endotoxin core (EndoCAb); 3 common staphylococcal epitopes and varicella on saved serum of 60 adult patients scheduled to undergo elective primary surgical aortic valve replacement (AVR). Primary outcome measure was post-operative length of stay (LOS) in hospital with secondary outcomes being development of infective complications, length of stay on the intensive care unit (ICU) and 30-day mortality. Patients were quartiled according to antibody levels and outcomes compared between the quartile groups using Mann-Whitney tests for length of stay and Fisher’s test for development of infection.ResultsSixty patients (34 M, 26 F) were recruited with mean age 73 years (IQR 66–78), mean body mass index (BMI) 27.7 (IQR 25–31) and EuroSCORE II 1.44 (0.95–1.99). Those patients in the lower quartile for pre-operative antibody level had a longer post-operative stay than the upper quartile. EndoCAb (median IgG level Q1 42.2 MU/ml vs Q4 256 MU/ml) 9 vs 6 days, p = 0.025; alpha-toxin (median IgG level Q1 63 U vs Q4 558 U) 10 vs 7 days, p = 0.034; teichoic acid (median IgG level Q1 14 U vs Q4 419 U) 10 vs 8 days, p = 0.441; staphylococcal enterotoxin A (median IgG level Q1 55 U vs Q4 427 U) 9 vs 7 days, p = 0.865; varicella zoster (median IgG level Q1 1.325 U vs Q4 2.54 U) 8 vs 7 days, p = 1.0; and combined antibody levels 10 vs 6 days, p = 0.017. There were no differences in the number developing post-operative infections for each antibody type. The combined antibody analysis suggested a reduction in proportion of individuals developing infection from the upper vs lower quartile: 0 vs 0.33, p = 0.042.ConclusionsThis study again suggests the inverse relationship between endotoxin core antibody levels and outcome following aortic valve surgery as well as suggesting a similar relationship with antibodies to staphylococcus. There is no such relationship for antibody levels against an organism not providing a peri-operative threat. Understanding this relationship may enable therapeutic manipulation of immune status, re-evaluation of risk and further investigation of the low immune state.Trial registrationThe patients in this study are a sub-group of the RELIEF AS study.ClinicalTrials.gov identifier NCT02174471.

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Morbidity outcomes after surgical aortic valve replacement

Cited by 21 publications

References 23 publications

Prevalence and prognostic implication of iron deficiency and anaemia in patients with severe aortic stenosis

Prevalence and prognostic implication of iron deficiency and anaemia in patients with severe aortic stenosis

Propensity score-matched analysis of patients with severe aortic stenosis undergoing surgical aortic valve replacement

Relationship between endotoxin core, staphylococcal and varicella antibody levels and outcome following aortic valve replacement surgery: a prospective observational study

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