Aortic Annular Enlargement in the Elderly: Short and Long-Term Outcomes in the United States
| Autor: | Vinod H. Thourani, J. Matthew Brennan, Maria V. Grau-Sepulveda, Gorav Ailawadi, Vinay Badhwar, J. Hunter Mehaffey, Robert B. Hawkins, John M. Fallon, Zachary K. Wegermann |
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| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty business.industry medicine.medical_treatment Hazard ratio Odds ratio medicine.disease Prosthesis Confidence interval Surgery Cardiac surgery medicine.anatomical_structure Aortic valve replacement medicine Cardiology and Cardiovascular Medicine business Survival analysis Artery |
| Zdroj: | The Annals of Thoracic Surgery. 112:1160-1166 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2020.12.023 |
| Popis: | Background Patient prosthesis mismatch is associated with significant long-term morbidity and mortality after aortic valve replacement, but the role and outcomes of annular enlargement (AE) remain poorly defined. We hypothesized that increasing rates of AE may lead to improved outcomes for patients at risk for severe patient prosthesis mismatch. Methods Patients over age 65 years undergoing surgical aortic valve replacement with or without coronary artery bypass grafting from 2008-2016 in The Society of Thoracic Surgeons Adult Cardiac Surgery Database with matching Centers for Medicare & Medicaid Services data were included (n=189,268). Univariate, multivariate, and time-to-event analysis was used to evaluate the association between AE and early and late outcomes. Patients were stratified by projected degree of patient prosthesis mismatch based on calculated effective orifice area index. Results A total of 5412 (2.9%) patients underwent AE. The Society of Thoracic Surgeons Adult Cardiac Surgery Database–predicted mortality was similar between AE and non-AE groups (2.97% vs 2.99%, P = .052). Patients undergoing AE had higher risk-adjusted rates of 30-day complications and death (5.4% vs 3.4%, P Conclusions These data suggest that annular enlargement during surgical aortic valve replacement is associated with increased short-term risk in a Medicare population. Survival curves crossed after 3 years, which may portend a benefit in select patients. However, annular enlargement is still only performed in the minority of patients who are at risk for patient prosthesis mismatch. |
| Databáze: | OpenAIRE |
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