1
|
Rajesh K, Chung M, Levine D, Norton E, Patel P, Childress P, Zhao Y, Wang P, Leshnower B, Kurlansky P, Chen E, Takayama H. Long-term outcomes after aortic root replacement for bicuspid aortic valve-associated aneurysm. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00204-6. [PMID: 38691070 DOI: 10.1016/j.jtcvs.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Patients with congenital bicuspid aortic valve often require root replacement. This study aims to describe their long-term rates of mortality and reoperation. METHODS This is a multicenter retrospective study of 747 patients with bicuspid aortic valve who underwent aortic root replacement for aortic aneurysm between 2004 and 2020. Cumulative incidence curves for aortic valve and aortic reoperations were graphed. A Kaplan-Meier survival curve for the patient cohort was created alongside an age- and sex-matched curve for the US population. Multivariable Cox regression was used to determine characteristics associated with long-term mortality. RESULTS The median age of our cohort was 54 [43-64] years old, and 101 (13.5%) patients were female. In patients with bicuspid aortic valve dysfunction, 274 (36.7%) had aortic insufficiency, 187 (25.0%) had aortic stenosis, and 142 (19.0%) had both. In-hospital mortality occurred in 10 (1.3%) patients. There were 56 aortic valve reoperations and 19 aortic reoperations, with a combined cumulative incidence of 35% (95% confidence interval [CI], 23%-46%) at 15 years. In addition, there was comparable survival between the patient cohort and the age- and sex-matched US population. Age (hazard ratio [HR], 1.04; 95% CI, 1.01-1.06), concomitant CABG (HR, 2.28; 95% CI, 1.29-4.04), and bypass time (HR, 1.01; 95% CI, 1.00-1.01) were associated with increased mortality. CONCLUSIONS Patients who undergo aortic root replacement with bicuspid aortic valve have an increased rate of aortic reoperation (35%; 95% CI, 23%-46%) while their survival appears to be comparable to the general US population (79%; 95% CI, 73%-87%) at 15 years.
Collapse
Affiliation(s)
- Kavya Rajesh
- Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY
| | - Megan Chung
- Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY
| | - Dov Levine
- Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY
| | - Elizabeth Norton
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Parth Patel
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Patra Childress
- Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY
| | - Yanling Zhao
- Center for Innovation and Outcomes Research, Columbia University, New York, NY
| | - Pengchen Wang
- Center for Innovation and Outcomes Research, Columbia University, New York, NY
| | - Bradley Leshnower
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Paul Kurlansky
- Center for Innovation and Outcomes Research, Columbia University, New York, NY
| | - Edward Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY.
| |
Collapse
|
2
|
Hernández-Vaquero D, Rodríguez-Caulo E, Vigil-Escalera C, Blanco-Herrera Ó, Berastegui E, Arias-Dachary J, Souaf S, Parody G, Laguna G, Adsuar A, Castellá M, Valderrama JF, Pulitani I, Cánovas S, Ferreiro A, García-Valentín A, Carnero M, Pareja P, Corrales JA, Blázquez JA, Macías D, Fletcher-Sanfeliu D, Martínez D, Martín E, Martín M, Margarit J, Hernández-Estefanía R, Monguió E, Otero J, Silva J. Life expectancy after surgical aortic valve replacement for low-gradient aortic stenosis with preserved ejection fraction. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:32-39. [PMID: 35732565 DOI: 10.1016/j.rec.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/29/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Surgical aortic valve replacement (SAVR) can modify the natural history of severe aortic stenosis (SAS). However, compared with the general population, these patients have a loss of life expectancy. The life expectancy of patients who undergo SAVR due to low-gradient SAS with preserved left ventricular ejection fraction (LVEF) is unknown. METHODS We included all patients between 50 and 65 years who underwent isolated SAVR in 27 Spanish centers during an 18-year period. We analyzed observed and expected survival at 18 years in patients with low-gradient SAS with preserved LVEF and all other types of SAS. We used propensity score matching to compare the life expectancy of patients with low-gradient SAS with preserved LVEF vs those with high-gradient SAS with preserved LVEF. RESULTS We analyzed 5084 patients, of whom 413 had low-gradient SAS with preserved LVEF. For these patients, observed survival at 10, 15 and 18 years was 86.6% (95%CI, 85.3-87.8), 75% (95%CI, 72.7-77.2), and 63.5% (95%CI, 58.8-67.8). Expected survival at 10, 15 and 18 years was 90.2%, 82.1%, and 75.7%. In the matched sample, survival of patients with low-gradient SAS with preserved LVEF was similar to that of patients with high-gradient with preserved LVEF, log-rank test, P=.95; HR=1 (95%CI, 0.7-1.4; P=.95). CONCLUSIONS There is a loss of life expectancy in patients with all types of SAS undergoing SAVR. This loss is higher in patients with left ventricular dysfunction and lower in patients with low-gradient or high-gradient aortic stenosis with preserved LVEF. The benefit of surgery is similar between these last 2 groups.
Collapse
Affiliation(s)
- Daniel Hernández-Vaquero
- Departamento de Cirugía Cardiaca, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | | | - Carlota Vigil-Escalera
- Departamento de Cirugía Cardiaca, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - Elisabet Berastegui
- Departamento de Cirugía Cardiaca, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Javier Arias-Dachary
- Departamento de Cirugía Cardiaca, Hospital Universitario Reina Sofía, Cordoba, Spain
| | - Souhayla Souaf
- Departamento de Cirugía Cardiaca, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Gertrudis Parody
- Departamento de Cirugía Cardiaca, Hospital Universitario Virgen de la Macarena, Seville, Spain
| | - Gregorio Laguna
- Departamento de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Alejandro Adsuar
- Departamento de Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Manel Castellá
- Departamento de Cirugía Cardiaca, Hospital Clinic de Barcelona, Barcelona, Spain
| | - José F Valderrama
- Departamento de Cirugía Cardiaca, Hospital Universitario Regional de Málaga, Malaga, Spain
| | - Ivana Pulitani
- Departamento de Cirugía Cardiaca, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Sergio Cánovas
- Departamento de Cirugía Cardiaca, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Andrea Ferreiro
- Departamento de Cirugía Cardiaca, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Antonio García-Valentín
- Departamento de Cirugía Cardiaca, Hospital General Universitario de Alicante, Alicante, Spain
| | - Manuel Carnero
- Departamento de Cirugía Cardiaca, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Pilar Pareja
- Departamento de Cirugía Cardiaca, Hospital Universitario Virgen de la Salud, Toledo, Spain
| | - José A Corrales
- Departamento de Cirugía Cardiaca, Hospital Universitario de Badajoz, Badajoz, Spain
| | - José A Blázquez
- Departamento de Cirugía Cardiaca, Hospital Universitario La Paz, Madrid, Spain
| | - Diego Macías
- Departamento de Cirugía Cardiaca, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - Delfina Fletcher-Sanfeliu
- Departamento de Cirugía Cardiaca, Hospital Universitario Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Daniel Martínez
- Departamento de Cirugía Cardiaca, Hospital Universitario Puerta del Hierro, Majadahonda, Madrid, Spain
| | - Elio Martín
- Departamento de Cirugía Cardiaca, Hospital Universitario de León, Leon, Spain
| | - Miren Martín
- Departamento de Cirugía Cardiaca, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Juan Margarit
- Departamento de Cirugía Cardiaca, Hospital Universitario De la Ribera, Alzira, Valencia, Spain
| | | | - Emilio Monguió
- Departamento de Cirugía Cardiaca, Hospital Universitario de La Princesa, Madrid, Spain
| | - Juan Otero
- Departamento de Cirugía Cardiaca, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Jacobo Silva
- Departamento de Cirugía Cardiaca, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| |
Collapse
|
3
|
Báez-Ferrer N, Avanzas P, Domínguez-Rodríguez A. Role of cardiopulmonary stress testing in patients with severe aortic stenosis. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:7-9. [PMID: 36096298 DOI: 10.1016/j.rec.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Nestor Báez-Ferrer
- Departamento de Cardiología, Hospital Universitario de Canarias, Tenerife, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Alberto Domínguez-Rodríguez
- Departamento de Cardiología, Hospital Universitario de Canarias, Tenerife, Spain; Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Tenerife, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| |
Collapse
|