Abstract
Background: Understanding of the risk factors for the development of adverse outcomes after aortic valve replacement is necessary to develop timely preventive measures and to improve the results of surgical treatment. Methods: We analyzed patients with aortic stenosis (n = 742) who underwent surgical treatment in the period 2014–2020. The average age was 63 (57;69) years—men 58%, women 42%. Results: The hospital mortality rate was 3% (22 patients). The following statistically significant threshold values (cut-off points) were obtained in the ROC analysis: aortic cross-clamp time > 93 min AUC (CI) 0.676 (0.640–0.710), p = 0.010; cardiopulmonary bypass time > 144 min AUC (CI) 0.809 (0.778–0.837), p < 0.0001, hemoglobin before op <120 g/L. AUC (CI) 0.762 (0.728–0.793), p < 0.0001, hematocrit before op <39% AUC (CI) 0.755 (0.721–0.786), p < 0.001, end-diastolic dimension index >2.39 AUC (CI) 0.647 (0.607–0.686), p = 0.014, end-systolic dimension index > 1.68 AUC (CI) 0.657 (0.617–0.695), p = 0.009. Statistically significant independent predictors of hospital mortality were identified: BMI > 30 kg/m2 (OR 2.84; CI 1.15–7.01), ischemic heart disease (OR 3.65; CI 1.01–13.2), diabetes (OR 3.88; CI 1.38–10.9), frequent ventricular ectopy before operation (OR 9.78; CI 1.91–50.2), mitral valve repair (OR 4.47; CI 1.76–11.3), tricuspid valve repair (OR 3.06; CI 1.09–8.58), 3 and more procedures (OR 4.44; CI 1.67–11.8). Conclusions: The hospital mortality rate was 3%. The main indicators associated with the risk of death were: diabetes, overweight (body mass index more than 30 kg/m2), frequent ventricular ectopy before surgery, hemoglobin level below 120 g/L, hematocrit level below 39%, longer cardiopulmonary bypass time and aortic cross-clamp time, additional mitral and tricuspid valve interventions.
Highlights
Aortic valve stenosis is among the most common pathologies of the heart valve apparatus, which is diagnosed in 2–5% of the adult population [1]
Aortic valve replacement is recommended for most patients with severe aortic stenosis, whereas conservative treatment neither improves survival, nor slows down the progression of this defect [4,6,7]
We considered frequent ventricular extrasystole (FVE) and atrioventricular blockade as separate risk factors in uni- and multivariate logistic regression
Summary
Aortic valve stenosis is among the most common pathologies of the heart valve apparatus, which is diagnosed in 2–5% of the adult population [1]. Aortic stenosis is diagnosed in 4–12% of cases in patients over 65 years old and in 20% in the group over 80 years old [1–5]. Aortic valve replacement is recommended for most patients with severe aortic stenosis, whereas conservative treatment neither improves survival, nor slows down the progression of this defect [4,6,7]. Surgical aortic valve replacement (SAVR) of the affected valve represents standard treatment in the low risk group of patients (
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