December 12, 2012Open Access

Risk Factors for Late Valve-Related Mortality after Aortic Valve Replacement in Elderly Patients

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Aortic stenosis (n=132). Intervention: Aortic valve replacement. Primary outcome: Late valve-related mortality (risk per 10 g/m2 increase in preoperative left ventricular mass index) (HR 1.10, 95% CI 1.00-1.20, p=0.040).

Key Result

In elderly patients undergoing aortic valve replacement, significant independent risk factors for late valve-related mortality included increased preoperative left ventricular mass index (HR 1.10 per 10 g/m2), lack of sinus rhythm (HR 7.11), peak transvalvular pressure gradient <60 mmHg (HR 7.48), and liver cirrhosis (HR 10.07).

Study Design

Type

Cohort (n=132)

Multicenter

PICO

Population

Aortic stenosis (n=132)

Intervention / Comparator

Aortic valve replacement

Primary Outcome

Late valve-related mortality (risk per 10 g/m2 increase in preoperative left ventricular mass index) — HR 1.10 (1.00-1.20), p=0.040

Main Result

Effect estimate: HR 1.10 (95% CI 1.00-1.20)

p-value: p=0.040

Limitations

Retrospective study design with a very long period of data collection during which changes in prosthetic valves, surgeons, and drugs may have influenced results.
Effective orifice area of the prosthetic valve was not measured by echocardiography in all patients, requiring the use of catalogue data.
Focus on independent risk factors precluded the assessment of mixed factors, such as a low gradient with a low left ventricular ejection fraction.

Abstract

PURPOSE: Few recent studies have examined the long-term outcomes after aortic valve replacement (AVR), and independent predictors for long-term survival and valve-related mortality have not been elucidated. METHODS: From January 1993 to December 2009, 132 elderly patients (≥70 years old) with aortic stenosis underwent AVR in our hospital. The patients comprised 61 men and71 women with a mean age of 76.1 ± 3.7 years. Patients with acute or old myocardial infarction, mitral valve disease, and re-do surgery were not included in this study. Risk factors for late valve-related mortality were examined. RESULTS: The 5-year freedom from valve-related mortality rate was 89.6%. The following significant independent risk factors for late valve-related mortality were identified:increase in the preoperative left ventricular mass index (hazard ratio, 1.10 per 10 g/m(2);p = 0.040); lack of sinus rhythm (hazard ratio, 7.11; p = 0.005); peak transvalvular pressure gradient of <60 mmHg (hazard ratio, 7.48; p = 0.008). CONCLUSION: In the elderly, AVR should be performed at an early stage of aortic stenosis, before an increase in the left ventricular mass index has occured, and while the heart rhythm is in sinus rhythm and the peak transvalvular pressure gradient is high.

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Cite This Study

Hosono et al. (Wed,) conducted a cohort in Aortic stenosis (n=132). Aortic valve replacement was evaluated on Late valve-related mortality (risk per 10 g/m2 increase in preoperative left ventricular mass index) (HR 1.10, 95% CI 1.00-1.20, p=0.040). In elderly patients undergoing aortic valve replacement, significant independent risk factors for late valve-related mortality included increased preoperative left ventricular mass index (HR 1.10 per 10 g/m2), lack of sinus rhythm (HR 7.11), peak transvalvular pressure gradient <60 mmHg (HR 7.48), and liver cirrhosis (HR 10.07).

synapsesocial.com/papers/6a0cc8e6a4d785ea8162582d https://doi.org/https://doi.org/10.5761/atcs.oa.12.01983