Abstract 16999: Analysis of Risk Factors for Mortality and Morbidity of Surgical Aortic Valve Replacement for Aortic Stenosis: Risk Models From a Japanese Database

Abstract

Background: Surgical aortic valve replacement (sAVR) is the standard treatment for atherosclerotic aortic stenosis; however, trans-catheter aortic valve replacement (tAVR) is being increasingly used for high risk patients. The risks associated with sAVR have usually been assessed by operative mortality. However, it may be meaningful to assess the risk for operative morbidity. Purpose: This study aimed to create risk models associated with sAVR for mortality, as well as for combined mortality and morbidity (M-M), using the Japan Adult Cardiovascular Surgery Database. Methods: A total of 14,100 patients who underwent sAVR with/without CABG between 2009 and 2012 were retrospectively evaluated. We excluded patients with contraindications to tAVR, except for chronic dialysis. Multiple logistic regression analysis was used to create a risk model for mortality (30 days postoperative and in-hospital), and for M-M (patient was hospitalized longer than 90 days or patient’s daily activities were disturbed with a modified Rankin scale of 4 or more at discharge). Results: Mortality was 3.1%, and rate of M-M was 10.9%. Significant risk factors are listed in the table. Risk factors common to both mortality and M-M were older age, chronic dialysis, atrial fibrillation, higher NYHA class, chronic lung disease, cerebrovascular disease, and congestive heart failure. Risk factors specific to M-M were history of psychoneurotic disorder, diabetes mellitus, obesity, and left ventricular dysfunction. Conclusions: Analyzing the risk factors not only for mortality but also for M-M may be useful in identifying appropriate candidates for tAVR.