The Impact of Specific Preoperative Organ Dysfunction in Patients Undergoing Aortic Valve Replacement
Background Optimizing treatment strategies to risk profile patients undergoing aortic valve replacement remains a priority. The role that specific and combinations of preoperative organ dysfunction (OD) plays in informing these decisions remains uncertain. This study sought to determine the relative...
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| Veröffentlicht in: | The Annals of thoracic surgery 2013-03, Vol.95 (3), p.838-845 |
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| creator | Thourani, Vinod H., MD Chowdhury, Ritam, MD Gunter, Rebecca L., BA Kilgo, Patrick D., MSc Chen, Edward P., MD Puskas, John D., MD Halkos, Michael E., MD Lattouf, Omar M., MD Cooper, William A., MD Guyton, Robert A., MD |
| description | Background Optimizing treatment strategies to risk profile patients undergoing aortic valve replacement remains a priority. The role that specific and combinations of preoperative organ dysfunction (OD) plays in informing these decisions remains uncertain. This study sought to determine the relative effect that OD in particular systems has on short- and long-term outcomes. Methods A total of 1,759 aortic valve replacement cases with and without coronary artery bypass grafting performed from January 2002 to June 2010 at Emory University are the basis for this retrospective analysis. Patients were classified by the presence or absence of preoperative OD: (1) cardiac: congestive heart failure (ejection fraction |
| doi_str_mv | 10.1016/j.athoracsur.2012.09.035 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1312848920</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S000349751202125X</els_id><sourcerecordid>1312848920</sourcerecordid><originalsourceid>FETCH-LOGICAL-c495t-b3d3fc5a9ff2bf59644569d5e6ccf6f0877498dc9d614308b5e06c1621f9f6323</originalsourceid><addsrcrecordid>eNqNkU1v1DAQhi0EokvhLyAfuST4e-MLUilflSq1oi3iZnmd8dZLYgc7qbT_Hq-2gMSJ02g07zujeV6EMCUtJVS93bV2vk_ZurLklhHKWqJbwuUTtKJSskYxqZ-iFSGEN0Kv5Ql6UcqutqyOn6MTxpmQQqxXCG7vAV-Mk3UzTh7fTOCCDw5fZ0gTZDuHB8BXeWsj_rAvfoluDiniEPF1nUGcC76LPeRtCnGLz1Keq_mbHarrK0yDdTBW0Uv0zNuhwKvHeoruPn28Pf_SXF59vjg_u2yc0HJuNrzn3kmrvWcbL7USQirdS1DOeeVJt14L3fVO94oKTrqNBKIcVYx67RVn_BS9Oe6dcvq5QJnNGIqDYbAR0lIM5ZR1otOMVGl3lLqcSsngzZTDaPPeUGIOkM3O_IVsDpAN0aZCrtbXj1eWzQj9H-NvqlXw_iiA-utDgGyKq6wc9CGDm02fwv9ceffPEjeEGJwdfsAeyi4tOVaWhppSPebmEPYha8pqykx-578ApWmoxg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1312848920</pqid></control><display><type>article</type><title>The Impact of Specific Preoperative Organ Dysfunction in Patients Undergoing Aortic Valve Replacement</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Thourani, Vinod H., MD ; Chowdhury, Ritam, MD ; Gunter, Rebecca L., BA ; Kilgo, Patrick D., MSc ; Chen, Edward P., MD ; Puskas, John D., MD ; Halkos, Michael E., MD ; Lattouf, Omar M., MD ; Cooper, William A., MD ; Guyton, Robert A., MD</creator><creatorcontrib>Thourani, Vinod H., MD ; Chowdhury, Ritam, MD ; Gunter, Rebecca L., BA ; Kilgo, Patrick D., MSc ; Chen, Edward P., MD ; Puskas, John D., MD ; Halkos, Michael E., MD ; Lattouf, Omar M., MD ; Cooper, William A., MD ; Guyton, Robert A., MD</creatorcontrib><description>Background Optimizing treatment strategies to risk profile patients undergoing aortic valve replacement remains a priority. The role that specific and combinations of preoperative organ dysfunction (OD) plays in informing these decisions remains uncertain. This study sought to determine the relative effect that OD in particular systems has on short- and long-term outcomes. Methods A total of 1,759 aortic valve replacement cases with and without coronary artery bypass grafting performed from January 2002 to June 2010 at Emory University are the basis for this retrospective analysis. Patients were classified by the presence or absence of preoperative OD: (1) cardiac: congestive heart failure (ejection fraction <0.35), (2) pulmonary: forced expiratory volume in 1 second less than 50% predicted, (3) neurologic (prior stroke), and (4) renal: chronic renal failure. The impact of individual and combined OD on outcomes was evaluated. Kaplan-Meier survival estimates and Cox regression models were used to assess the relationship between OD and long-term survival. Results A total of 513 patients (29.2%) had at least one OD, including 95 patients (5.4%) with more than one OD. Organ dysfunction in each organ system was associated with poorer survival. Renal (hazard ratio, 3.90) and pulmonary (hazard ratio, 2.40) OD patients had poorer long-term survival, including 30-day mortality. Seven-year survival for OD patients is as follows: prior stroke, 48.6%; severe chronic obstructive pulmonary disease, 30.8%; congestive heart failure, 55.9%; and chronic renal failure, 11.7%. The sequential addition of OD systems was a powerful predictor of poorer long-term survival. Conclusions The presence of chronic renal failure most profoundly decreases survival, followed by severe chronic obstructive pulmonary disease and prior stroke. Furthermore, multiple OD systems significantly decrease short- and long-term survival.</description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/j.athoracsur.2012.09.035</identifier><identifier>PMID: 23245447</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Aged ; Aortic Valve - surgery ; Cardiothoracic Surgery ; Female ; Georgia - epidemiology ; Heart Valve Diseases - complications ; Heart Valve Diseases - mortality ; Heart Valve Prosthesis ; Hospital Mortality - trends ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic - complications ; Kidney Failure, Chronic - mortality ; Male ; Preoperative Period ; Prognosis ; Proportional Hazards Models ; Pulmonary Disease, Chronic Obstructive - complications ; Pulmonary Disease, Chronic Obstructive - mortality ; Retrospective Studies ; Risk Factors ; Surgery ; Treatment Outcome</subject><ispartof>The Annals of thoracic surgery, 2013-03, Vol.95 (3), p.838-845</ispartof><rights>The Society of Thoracic Surgeons</rights><rights>2013 The Society of Thoracic Surgeons</rights><rights>Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c495t-b3d3fc5a9ff2bf59644569d5e6ccf6f0877498dc9d614308b5e06c1621f9f6323</citedby><cites>FETCH-LOGICAL-c495t-b3d3fc5a9ff2bf59644569d5e6ccf6f0877498dc9d614308b5e06c1621f9f6323</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23245447$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thourani, Vinod H., MD</creatorcontrib><creatorcontrib>Chowdhury, Ritam, MD</creatorcontrib><creatorcontrib>Gunter, Rebecca L., BA</creatorcontrib><creatorcontrib>Kilgo, Patrick D., MSc</creatorcontrib><creatorcontrib>Chen, Edward P., MD</creatorcontrib><creatorcontrib>Puskas, John D., MD</creatorcontrib><creatorcontrib>Halkos, Michael E., MD</creatorcontrib><creatorcontrib>Lattouf, Omar M., MD</creatorcontrib><creatorcontrib>Cooper, William A., MD</creatorcontrib><creatorcontrib>Guyton, Robert A., MD</creatorcontrib><title>The Impact of Specific Preoperative Organ Dysfunction in Patients Undergoing Aortic Valve Replacement</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description>Background Optimizing treatment strategies to risk profile patients undergoing aortic valve replacement remains a priority. The role that specific and combinations of preoperative organ dysfunction (OD) plays in informing these decisions remains uncertain. This study sought to determine the relative effect that OD in particular systems has on short- and long-term outcomes. Methods A total of 1,759 aortic valve replacement cases with and without coronary artery bypass grafting performed from January 2002 to June 2010 at Emory University are the basis for this retrospective analysis. Patients were classified by the presence or absence of preoperative OD: (1) cardiac: congestive heart failure (ejection fraction <0.35), (2) pulmonary: forced expiratory volume in 1 second less than 50% predicted, (3) neurologic (prior stroke), and (4) renal: chronic renal failure. The impact of individual and combined OD on outcomes was evaluated. Kaplan-Meier survival estimates and Cox regression models were used to assess the relationship between OD and long-term survival. Results A total of 513 patients (29.2%) had at least one OD, including 95 patients (5.4%) with more than one OD. Organ dysfunction in each organ system was associated with poorer survival. Renal (hazard ratio, 3.90) and pulmonary (hazard ratio, 2.40) OD patients had poorer long-term survival, including 30-day mortality. Seven-year survival for OD patients is as follows: prior stroke, 48.6%; severe chronic obstructive pulmonary disease, 30.8%; congestive heart failure, 55.9%; and chronic renal failure, 11.7%. The sequential addition of OD systems was a powerful predictor of poorer long-term survival. Conclusions The presence of chronic renal failure most profoundly decreases survival, followed by severe chronic obstructive pulmonary disease and prior stroke. Furthermore, multiple OD systems significantly decrease short- and long-term survival.</description><subject>Aged</subject><subject>Aortic Valve - surgery</subject><subject>Cardiothoracic Surgery</subject><subject>Female</subject><subject>Georgia - epidemiology</subject><subject>Heart Valve Diseases - complications</subject><subject>Heart Valve Diseases - mortality</subject><subject>Heart Valve Prosthesis</subject><subject>Hospital Mortality - trends</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Kidney Failure, Chronic - complications</subject><subject>Kidney Failure, Chronic - mortality</subject><subject>Male</subject><subject>Preoperative Period</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Pulmonary Disease, Chronic Obstructive - complications</subject><subject>Pulmonary Disease, Chronic Obstructive - mortality</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0003-4975</issn><issn>1552-6259</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU1v1DAQhi0EokvhLyAfuST4e-MLUilflSq1oi3iZnmd8dZLYgc7qbT_Hq-2gMSJ02g07zujeV6EMCUtJVS93bV2vk_ZurLklhHKWqJbwuUTtKJSskYxqZ-iFSGEN0Kv5Ql6UcqutqyOn6MTxpmQQqxXCG7vAV-Mk3UzTh7fTOCCDw5fZ0gTZDuHB8BXeWsj_rAvfoluDiniEPF1nUGcC76LPeRtCnGLz1Keq_mbHarrK0yDdTBW0Uv0zNuhwKvHeoruPn28Pf_SXF59vjg_u2yc0HJuNrzn3kmrvWcbL7USQirdS1DOeeVJt14L3fVO94oKTrqNBKIcVYx67RVn_BS9Oe6dcvq5QJnNGIqDYbAR0lIM5ZR1otOMVGl3lLqcSsngzZTDaPPeUGIOkM3O_IVsDpAN0aZCrtbXj1eWzQj9H-NvqlXw_iiA-utDgGyKq6wc9CGDm02fwv9ceffPEjeEGJwdfsAeyi4tOVaWhppSPebmEPYha8pqykx-578ApWmoxg</recordid><startdate>20130301</startdate><enddate>20130301</enddate><creator>Thourani, Vinod H., MD</creator><creator>Chowdhury, Ritam, MD</creator><creator>Gunter, Rebecca L., BA</creator><creator>Kilgo, Patrick D., MSc</creator><creator>Chen, Edward P., MD</creator><creator>Puskas, John D., MD</creator><creator>Halkos, Michael E., MD</creator><creator>Lattouf, Omar M., MD</creator><creator>Cooper, William A., MD</creator><creator>Guyton, Robert A., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130301</creationdate><title>The Impact of Specific Preoperative Organ Dysfunction in Patients Undergoing Aortic Valve Replacement</title><author>Thourani, Vinod H., MD ; Chowdhury, Ritam, MD ; Gunter, Rebecca L., BA ; Kilgo, Patrick D., MSc ; Chen, Edward P., MD ; Puskas, John D., MD ; Halkos, Michael E., MD ; Lattouf, Omar M., MD ; Cooper, William A., MD ; Guyton, Robert A., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c495t-b3d3fc5a9ff2bf59644569d5e6ccf6f0877498dc9d614308b5e06c1621f9f6323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Aortic Valve - surgery</topic><topic>Cardiothoracic Surgery</topic><topic>Female</topic><topic>Georgia - epidemiology</topic><topic>Heart Valve Diseases - complications</topic><topic>Heart Valve Diseases - mortality</topic><topic>Heart Valve Prosthesis</topic><topic>Hospital Mortality - trends</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Kidney Failure, Chronic - complications</topic><topic>Kidney Failure, Chronic - mortality</topic><topic>Male</topic><topic>Preoperative Period</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Pulmonary Disease, Chronic Obstructive - complications</topic><topic>Pulmonary Disease, Chronic Obstructive - mortality</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thourani, Vinod H., MD</creatorcontrib><creatorcontrib>Chowdhury, Ritam, MD</creatorcontrib><creatorcontrib>Gunter, Rebecca L., BA</creatorcontrib><creatorcontrib>Kilgo, Patrick D., MSc</creatorcontrib><creatorcontrib>Chen, Edward P., MD</creatorcontrib><creatorcontrib>Puskas, John D., MD</creatorcontrib><creatorcontrib>Halkos, Michael E., MD</creatorcontrib><creatorcontrib>Lattouf, Omar M., MD</creatorcontrib><creatorcontrib>Cooper, William A., MD</creatorcontrib><creatorcontrib>Guyton, Robert A., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Annals of thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thourani, Vinod H., MD</au><au>Chowdhury, Ritam, MD</au><au>Gunter, Rebecca L., BA</au><au>Kilgo, Patrick D., MSc</au><au>Chen, Edward P., MD</au><au>Puskas, John D., MD</au><au>Halkos, Michael E., MD</au><au>Lattouf, Omar M., MD</au><au>Cooper, William A., MD</au><au>Guyton, Robert A., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Impact of Specific Preoperative Organ Dysfunction in Patients Undergoing Aortic Valve Replacement</atitle><jtitle>The Annals of thoracic surgery</jtitle><addtitle>Ann Thorac Surg</addtitle><date>2013-03-01</date><risdate>2013</risdate><volume>95</volume><issue>3</issue><spage>838</spage><epage>845</epage><pages>838-845</pages><issn>0003-4975</issn><eissn>1552-6259</eissn><abstract>Background Optimizing treatment strategies to risk profile patients undergoing aortic valve replacement remains a priority. The role that specific and combinations of preoperative organ dysfunction (OD) plays in informing these decisions remains uncertain. This study sought to determine the relative effect that OD in particular systems has on short- and long-term outcomes. Methods A total of 1,759 aortic valve replacement cases with and without coronary artery bypass grafting performed from January 2002 to June 2010 at Emory University are the basis for this retrospective analysis. Patients were classified by the presence or absence of preoperative OD: (1) cardiac: congestive heart failure (ejection fraction <0.35), (2) pulmonary: forced expiratory volume in 1 second less than 50% predicted, (3) neurologic (prior stroke), and (4) renal: chronic renal failure. The impact of individual and combined OD on outcomes was evaluated. Kaplan-Meier survival estimates and Cox regression models were used to assess the relationship between OD and long-term survival. Results A total of 513 patients (29.2%) had at least one OD, including 95 patients (5.4%) with more than one OD. Organ dysfunction in each organ system was associated with poorer survival. Renal (hazard ratio, 3.90) and pulmonary (hazard ratio, 2.40) OD patients had poorer long-term survival, including 30-day mortality. Seven-year survival for OD patients is as follows: prior stroke, 48.6%; severe chronic obstructive pulmonary disease, 30.8%; congestive heart failure, 55.9%; and chronic renal failure, 11.7%. The sequential addition of OD systems was a powerful predictor of poorer long-term survival. Conclusions The presence of chronic renal failure most profoundly decreases survival, followed by severe chronic obstructive pulmonary disease and prior stroke. Furthermore, multiple OD systems significantly decrease short- and long-term survival.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>23245447</pmid><doi>10.1016/j.athoracsur.2012.09.035</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Aortic Valve - surgery Cardiothoracic Surgery Female Georgia - epidemiology Heart Valve Diseases - complications Heart Valve Diseases - mortality Heart Valve Prosthesis Hospital Mortality - trends Humans Kaplan-Meier Estimate Kidney Failure, Chronic - complications Kidney Failure, Chronic - mortality Male Preoperative Period Prognosis Proportional Hazards Models Pulmonary Disease, Chronic Obstructive - complications Pulmonary Disease, Chronic Obstructive - mortality Retrospective Studies Risk Factors Surgery Treatment Outcome |
| title | The Impact of Specific Preoperative Organ Dysfunction in Patients Undergoing Aortic Valve Replacement |
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