Can postoperative mean transprosthetic pressure gradient predict survival after aortic valve replacement?

Bart M Koene,Kathinka C Peels,Jan-Melle Van Dantzig,Mohamed A Soliman Hamad,Wobbe Bouma,Massimo A Mariani,Albert H Van Straten

doi:10.1007/s00392-013-0629-3

Abstract

Background In this study, we sought to determine the effect of the mean transprosthetic pressure gradient (TPG), measured at 6 weeks after aortic valve replacement (AVR) or AVR with coronary artery bypass grafting (CABG) on late all-cause mortality.MethodsBetween January 1998 and March 2012, 2,276 patients (mean age 68 ± 11 years) underwent TPG analysis at 6 weeks after AVR (n = 1,318) or AVR with CABG (n = 958) at a single institution. Mean TPG was 11.6 ± 7.8 mmHg and median TPG 11 mmHg. Based on the TPG, the patients were split into three groups: patients with a low TPG (<10 mmHg), patients with a medium TPG (10–19 mmHg) and patients with a high TPG (≥20 mmHg). Cox proportional-hazard regression analysis was used to determine univariate predictors and multivariate independent predictors of late mortality.ResultsOverall survival for the entire group at 1, 3, 5, and 10 years was 97, 93, 87 and 67 %, respectively. There was no significant difference in long-term survival between patients with a low, medium or high TPG (p = 0.258). Independent predictors of late mortality included age, diabetes, peripheral vascular disease, renal dysfunction, chronic obstructive pulmonary disease, a history of a cerebrovascular accident and cardiopulmonary bypass time. Prosthesis–patient mismatch (PPM), severe PPM and TPG measured at 6 weeks postoperatively were not significantly associated with late mortality.ConclusionsTPG measured at 6 weeks after AVR or AVR with CABG is not an independent predictor of all-cause late mortality and there is no significant difference in long-term survival between patients with a low, medium or high TPG.

Highlights

In this study, we sought to determine the effect of the mean transprosthetic pressure gradient (TPG), measured at 6 weeks after aortic valve replacement (AVR) or AVR with coronary artery bypass grafting (CABG) on late all-cause mortality
Prosthesis–patient mismatch (PPM), severe prosthesis–patient mismatch (PPM) and TPG measured at 6 weeks postoperatively were not significantly associated with late mortality
TPG measured at 6 weeks after AVR or AVR with CABG is not an independent predictor of allcause late mortality and there is no significant difference in long-term survival between patients with a low, medium or high TPG

Summary

Results

Univariate analysis revealed the following predictors of late mortality: age, severely impaired LV function [25], hypertension, diabetes, PVD, renal dysfunction [25], COPD, history of CVA, the use of a mechanical prosthesis, concomitant CABG, CPB time and aortic cross-clamp time. PPM, severe PPM and TPG as a continuous variable or as categorical variable (gradient group) were not significant predictors of late mortality at univariate analysis. The fact that PPM does not affect long-term survival is consistent with other studies [7, 19, 24, 40,41,42,43,44] Most operative characteristics, such as the use of mechanical valve prostheses, concomitant CABG, CPB time, aortic cross-clamp time were significantly different between the groups. The relatively short mean follow-up of 5.5 years limits conclusions about the long-term effect of TPG on survival

Background

Study design

Conclusions