Mortality characteristics of aortic root surgery in North America.

Published

Journal Article

Aortic root surgery is transitioning to aortic valve sparing (AVS), but little is known about the relative early outcomes of AVS versus composite graft-valve replacement (CVR). This study assessed mortality differences for AVS versus CVR to guide future practice decisions.From January 2000 to June 2011, 31 747 patients had aortic root replacement with AVS (n = 3585; 11%) or CVR (n = 28 162; 89%). The cohort of Overall patients was divided into two subgroups: high-risk patients (n = 20 356; 6% AVS) having age >75 years, endocarditis, aortic stenosis, dialysis, multiple valves, reoperation or emergency/salvage status, and the remaining low-risk patients (n = 11 388; 21% AVS). Using logistic regression analysis, outcomes were presented as unadjusted operative mortality (UOM), risk-adjusted operative mortality (AOM) and adjusted odds ratio (AOR) for mortality.Baseline characteristics for the Overall group (AVS versus CVR) were: mean age (52 vs 57 years), endocarditis (1 vs 11%), aortic stenosis (4 vs 36%), dialysis (1 vs 2%), multiple valves (7 vs 10%), reoperation (6 vs 17%) and emergency status (14 vs 12%) (all P < 0.0001). In high- and low-risk groups, baseline differences narrowed, and lower mortality was generally observed with AVS: (AVS versus CVR) UOM group Overall (4.5 vs 8.9%)*, group High-risk (10.5 vs 11.7%), group Low-risk (1.4 vs 3.1%)*; AOM group Overall (6.2 vs 8.6%), group High-risk (10.1 vs 11.7%), group Low-risk (2.2 vs 2.8%); AOR group Overall (0.59)*, group High-risk (0.62)*, group Low-risk (0.69). *P < 0.05.Relative risk-adjusted mortality seemed comparable with AVS versus CVR in low- and high-risk subgroups. These data support judicious expansion of aortic valve repair in patients having aortic root replacement.

Full Text

Duke Authors

Cited Authors

  • Caceres, M; Ma, Y; Rankin, JS; Saha-Chaudhuri, P; Englum, BR; Gammie, JS; Suri, RM; Thourani, VH; Esmailian, F; Czer, LS; Puskas, JD; Svensson, LG

Published Date

  • November 2014

Published In

Volume / Issue

  • 46 / 5

Start / End Page

  • 887 - 893

PubMed ID

  • 24639452

Pubmed Central ID

  • 24639452

Electronic International Standard Serial Number (EISSN)

  • 1873-734X

International Standard Serial Number (ISSN)

  • 1010-7940

Digital Object Identifier (DOI)

  • 10.1093/ejcts/ezu083

Language

  • eng