Outcomes and Predictors of Mortality After Mitral Valve Surgery in High-Risk Elderly Patients: The Heidelberg Experience

Mkalaluh, Sabreen; Szczechowicz, Marcin; Dib, Bashar; Szabo, Gábor; Kretzler, Matthias; Weymann, Alexander

doi:10.12659/msm.906003

Cited by 11 publications

(13 citation statements)

References 25 publications

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“…Emergency/salvage surgery was found to be an independent predictor of 30-day mortality, similar to other study results [10,11,7]. The pathologies that mandate emergency valve surgery, including acute mitral incompetence following acute myocardial infarction or acute valve incompetence secondary to infective endocarditis, put the patient in a state of acute HF, increasing the risk of death.…”

supporting

confidence: 87%

“…Older patients have multiple comorbidities with deterioration of organ function. In patients > 80 years old, emergency surgery and CABG were the most important predictors of early mortality after mitral valve surgery (both repair and replacement), with estimated mortality of 18% [10]. Similarly, in patients undergoing AVR, emergency surgery, atrial brillation, and older age were the strongest predictors of mortality [11].…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Short-Term Mortality after Heart Valve Surgery: A Single-Center Study; Retrospective analysis

Ibrahim

Kheirallah

Mayyas

et al. 2020

Preprint

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Objective To investigate predictors of short-term mortality after valve surgery at our center. Methods The study cohort included 346 patients who underwent different types of valve surgery, excluding redo and Bentall operations. All operations were performed through a median sternotomy using cardiopulmonary bypass. Results Mean patient age was 51.6 ± 16.1 years, and 51% were male. Approximately 21% had diabetes, and 44.6% were hypertensive. Aortic valve replacement (AVR) was performed in 125 patients (37%), mitral valve replacement (MVR) in 95 (28%), combined AVR and MVR in 42 (13%), AVR plus coronary artery bypass grafting (CABG) in 19 (6%), and MVR plus CABG in 32 (10%). Operative mortality was 5.8% (n = 20). In the bivariate-level analysis, older age, operation type, hypertension, emergency surgery, use of a biological valve in the aortic or mitral position, pump time greater than 120 minutes, and aortic clamp time greater than 60 minutes were significant predictors of 30-day mortality. Use of angiotensin-converting enzyme inhibitors, digoxin, beta-blockers, statins, and loop diuretics was associated with mortality. Older age, emergency/salvage surgery, use of beta-blockers for less than 1 month preoperatively, and use of a biological valve in the aortic position were significant and independent predictors of 30-day mortality. Conclusion Older age, emergency valve surgery, use of a biological valve, and use of beta-blockers for less than 1 month before surgery were all found to be independent predictors of mortality in patients undergoing valve surgery.

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confidence: 87%

Section: Discussionmentioning

confidence: 99%

Predictors of Short-Term Mortality after Heart Valve Surgery: A Single-Center Study; Retrospective analysis

Ibrahim

Kheirallah

Mayyas

et al. 2020

Preprint

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“…16,19 In our study, this group of patients had the highest in hospital mortality rate, that is, 14.3%, and these results are in line with current literature. 20,21 In con trast to our results, Mkalaluh et al 22 determined CABG as the only concomitant procedure that was a predictor of early mortality after MV sur gery. The discrepancy might result from different regarding etiological factor of MR (P = 0.13) ( TABLE 3 and 4).…”

Section: What's Newsupporting

confidence: 57%

“…Furthermore, we classified eti ologies of MR not only on the basis of echocar diographic criteria but also surgical findings. In the Euro Heart Survey study, where surgical patient characteristics, as Mkalaluh et al 22 an alyzed only octogenarians, and patients in our study were much younger. In this study, besides concomitant other valve surgery, other factors associated with higher risk of death were age, severe heart failure symptoms, impaired LVEF, previous percutaneous coro nary interventions, CPB time, LCO, and wound infections.…”

Section: What's Newmentioning

confidence: 57%

Impact of the mechanism of mitral regurgitation on clinical outcomes in patients after mitral valve surgery

et al. 2019

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BACKGROUND Mitral regurgitation (MR) is the second most frequent indication for valve surgery. There are few studies addressing mitral valve (MV) surgery in the context of etiology of MR. AIMS We aimed to compare postoperative outcomes in the context of the etiological mechanism of MR in patients after MV surgery. METHODS The study group included 337 consecutive patients with severe MR. Preoperative comorbidities, postoperative clinical course, and predictors of in-hospital mortality were assessed. RESULTS Primary etiology of MR was observed in 72% of patients, and of secondary, in 28% (P <0.001). Among the primary MR group, the most common etiological factor was fibroelastic deficiency (79%), followed by Barlow disease (16%) and rheumatic disease (5%) (P <0.001). Secondary MR was seen in ischemic heart disease (67%) and dilated cardiomyopathy (33%) (P <0.001). The incidence of death and complications following surgery did not differ between the groups. Univariate analysis revealed that higher risk of death was associated with older age, severe heart failure symptoms, impaired left ventricular ejection fraction, previous percutaneous coronary interventions, cardiopulmonary bypass time, low cardiac output syndrome, and wound infections (P = 0.004, P <0.001, P = 0.005, P = 0.009, P = 0.002, P = 0.006, and P = 0.03, respectively). Also MV replacement with concomitant other valve surgery increased the risk of mortality (P = 0.049). CONCLUSIONS This study indicates that the clinical outcomes and in-hospital mortality in patients with severe MR correlate with the type of procedure and concomitant perioperative comorbidities rather than the etiological mechanism of MR itself.

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“…Chronic obstructive pulmonary disease (COPD) is one of the comorbidities that has been associated with the decision to not operate [9]. However, in a recent study, Mkalaluh et al [10] analyzed a contemporary series of octogenarians undergoing mitral valve surgery at their institution and found that COPD did not influence 30-day mortality.…”

Section: Introductionmentioning

confidence: 99%

Trends, characteristics, in-hospital outcomes and mortality in surgical mitral valve replacement among patients with and without COPD in Spain (2001-2015)

et al. 2019

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Purpose We examined trends, characteristics and in-hospital outcomes in mechanical and bioprosthetic surgical mitral valve replacement (SMVR) among patients with and without chronic obstructive pulmonary disease (COPD) in Spain from 2001 to 2015. We also identified factors associated with in-hospital mortality (IHM) in both groups of patients according to the implanted valve type. Methods We analyzed data from the Spanish National Hospital Discharge Database for patients aged 40 years or over. We selected admissions of patients whose medical procedures included SMVR. We grouped hospitalizations by COPD status. Results Over 43,024 patients identified, 83.63% underwent mechanical mitral valve replacement and 16.37% bioprosthetic valve (6.71% and 7.78% with COPD, respectively). The incidence of SMVR decreased for mechanical valves and increased for bioprosthetic valves over time in both groups of patients. The incidence of SMVR admissions was lower among COPD patients than in those without COPD, both for mechanical and bioprosthetic valves. IHM decreased significantly over time, regardless of the type of valve, in both groups of patients. COPD was associated with a significant increase in IHM, but only among patients who underwent bioprosthetic SMVR (OR 1.32, 95% CI 1.01–1.73). Conclusions The incidence of mechanical SMVR decreased while that of bioprosthetic SMVR increased over time in both groups of patients. COPD patients were less surgically operated than non-COPD patients for both valve types. In COPD patients, bioprosthetic SMVR was proportionally more used than mechanical SMVR. Mortality decreased over time for both valve types in patients with and without COPD. COPD increased in-hospital mortality among patients undergoing a biological SMVR.

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Outcomes and Predictors of Mortality After Mitral Valve Surgery in High-Risk Elderly Patients: The Heidelberg Experience

Cited by 11 publications

References 25 publications

Predictors of Short-Term Mortality after Heart Valve Surgery: A Single-Center Study; Retrospective analysis

Predictors of Short-Term Mortality after Heart Valve Surgery: A Single-Center Study; Retrospective analysis

Impact of the mechanism of mitral regurgitation on clinical outcomes in patients after mitral valve surgery

Trends, characteristics, in-hospital outcomes and mortality in surgical mitral valve replacement among patients with and without COPD in Spain (2001-2015)

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