Mid-term results of aortic valve surgery in redo scenarios in the current practice: results from the multicentre European RECORD (REdo Cardiac Operation Research Database) initiative
OBJECTIVES Although commonly reported as single-centre experiences, redo aortic valve replacement (RAVR) has overall acceptable results. Nevertheless, trans-catheter aortic valve replacement has recently questioned the efficacy of RAVR. METHODS Early-to-mid-term results and determinants of mortality...
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| Veröffentlicht in: | European journal of cardio-thoracic surgery 2015-02, Vol.47 (2), p.269-280 |
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| creator | Onorati, Francesco Biancari, Fausto De Feo, Marisa Mariscalco, Giovanni Messina, Antonio Santarpino, Giuseppe Santini, Francesco Beghi, Cesare Nappi, Giannantonio Troise, Giovanni Fischlein, Theodor Passerone, Giancarlo Heikkinen, Juni Faggian, Giuseppe |
| description | OBJECTIVES
Although commonly reported as single-centre experiences, redo aortic valve replacement (RAVR) has overall acceptable results. Nevertheless, trans-catheter aortic valve replacement has recently questioned the efficacy of RAVR.
METHODS
Early-to-mid-term results and determinants of mortality in 711 cases of RAVR from seven European institutions were assessed in the entire population and in selected high-risk subgroups [elderly >75 years, urgent/emergent procedures, preoperative New York Heart Association (NYHA) functional Class IV and endocarditis].
RESULTS
Hospital mortality was 5.1%, major re-entry cardiovascular complications (MRCVCs) 4.9%, low cardiac output syndrome (LCOS) 15.3%, stroke 6.6%, acute respiratory failure (ARF) 10.6%, acute renal insufficiency (ARI) 19.3% and need for continuous renal replacement therapy (CRRT) 7.2%, transfusions 66.9% and for permanent pacemaker (PMK) 12.7%. Mid-term survival, freedom from acute heart failure (AHF), reinterventions, stroke and thrombo-embolisms were 77.2 ± 2.7, 84.4 ± 2.6, 97.2 ± 0.8, 97.2 ± 0.9 and 96.3 ± 1.2%, respectively; 87.5% of patients were in NYHA functional Class I–II. Preoperative left ventricular ejection fraction of 75 years had similar hospital mortality (P = 0.06) and major morbidity, except for a higher need for PMK (P = 0.03), as well as comparable mid-term survival (P = 0.89), freedom from AHF (P = 0.81), reinterventions (P = 0.63), stroke (P = 0.21) and thrombo-embolisms (P = 0.09). Urgent/emergent indication resulted in higher hospital death, LCOS, transfusions, MRCVCs, intra-aortic balloon pumping (IABP), stroke, prolonged (>48 h) ventilation, pneumonia, ARI, CRRT, lower mid-term survival and freedom from AHF (P ≤ 0.03). Preoperative NYHA functional Class IV correlated with higher LCOS, IABP, prolonged ventilation, pneumonia, ARF, ARI, CRRT and MRCVCs and lower mid-term survival, freedom from AHF, reinterventions and stroke (P ≤ 0.02). E |
| doi_str_mv | 10.1093/ejcts/ezu116 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1645777169</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ejcts/ezu116</oup_id><sourcerecordid>1645777169</sourcerecordid><originalsourceid>FETCH-LOGICAL-c357t-6d2683f8964b893a778c8023ddf1b43b34b5ac3da0babc32d5b681ebd6c9da553</originalsourceid><addsrcrecordid>eNp9kc1u1DAUhSMEoqWwY428o0iE2nFiJ-zQdPiRikYagcQuurZvqKtJHK6dkcqD9fnqdkqXrPxzPn9X8imK14J_ELyTZ3hlUzzDv4sQ6klxLFotSy3rX0_zngte6q7mR8WLGK8450pW-nlxVNWqVZyL4-Lmu3dlQhoZYVx2KbIwMAiUvGV72O2RxYV-I10zP2XEBRYtTkA-xLubdInMLkQ4JTYT2PwMPz6qBgrjPTLmY06mRMjWC4UZYWLb9WqzPWen23W2roCcB8s2MxIkH3KMEYHsJTuHBAYivssDffI53ePL4tkAu4ivHtaT4ufn9Y_V1_Ji8-Xb6tNFaWWjU6lcpVo5tJ2qTdtJ0Lq1La-kc4MwtTSyNg1Y6YAbMFZWrjGqFWicsp2DppEnxenBO1P4s2BM_ejzB-x2MGFYYi9U3Witheoy-v6AWgoxEg79TH4Euu4F7--a6u-b6g9NZfzNg3kxI7pH-F81GXh7AMIy_191C1F4oj0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1645777169</pqid></control><display><type>article</type><title>Mid-term results of aortic valve surgery in redo scenarios in the current practice: results from the multicentre European RECORD (REdo Cardiac Operation Research Database) initiative</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Onorati, Francesco ; Biancari, Fausto ; De Feo, Marisa ; Mariscalco, Giovanni ; Messina, Antonio ; Santarpino, Giuseppe ; Santini, Francesco ; Beghi, Cesare ; Nappi, Giannantonio ; Troise, Giovanni ; Fischlein, Theodor ; Passerone, Giancarlo ; Heikkinen, Juni ; Faggian, Giuseppe</creator><creatorcontrib>Onorati, Francesco ; Biancari, Fausto ; De Feo, Marisa ; Mariscalco, Giovanni ; Messina, Antonio ; Santarpino, Giuseppe ; Santini, Francesco ; Beghi, Cesare ; Nappi, Giannantonio ; Troise, Giovanni ; Fischlein, Theodor ; Passerone, Giancarlo ; Heikkinen, Juni ; Faggian, Giuseppe</creatorcontrib><description>OBJECTIVES
Although commonly reported as single-centre experiences, redo aortic valve replacement (RAVR) has overall acceptable results. Nevertheless, trans-catheter aortic valve replacement has recently questioned the efficacy of RAVR.
METHODS
Early-to-mid-term results and determinants of mortality in 711 cases of RAVR from seven European institutions were assessed in the entire population and in selected high-risk subgroups [elderly >75 years, urgent/emergent procedures, preoperative New York Heart Association (NYHA) functional Class IV and endocarditis].
RESULTS
Hospital mortality was 5.1%, major re-entry cardiovascular complications (MRCVCs) 4.9%, low cardiac output syndrome (LCOS) 15.3%, stroke 6.6%, acute respiratory failure (ARF) 10.6%, acute renal insufficiency (ARI) 19.3% and need for continuous renal replacement therapy (CRRT) 7.2%, transfusions 66.9% and for permanent pacemaker (PMK) 12.7%. Mid-term survival, freedom from acute heart failure (AHF), reinterventions, stroke and thrombo-embolisms were 77.2 ± 2.7, 84.4 ± 2.6, 97.2 ± 0.8, 97.2 ± 0.9 and 96.3 ± 1.2%, respectively; 87.5% of patients were in NYHA functional Class I–II. Preoperative left ventricular ejection fraction of <30% [odds ratio (OR) 8.7, 95% confidence interval (CI) 2.1–35.6], MRCVCs (OR 20.9, 95% CI 5.6–78.3), cardiopulmonary bypass time (OR 1.1, 95% CI 1.0–1.1), perioperative LCOS (OR 17.2, 95% CI 5.1–57.4) and ARI (OR 5.1, 95% CI 1.5–18.1) predicted hospital death. Endocarditis (OR 7.5, 95% CI 2.9–19.1), preoperative NYHA functional Class IV (OR 4.7, 95% CI 1.0–24.0), combined RAVR + mitral surgery (OR 5.1, 95% CI 1.5–17.3) and AHF at follow-up (OR 2.8, 95% CI 1.3–6.0) predicted late death at the Cox proportional hazard regression model. Elderly >75 years had similar hospital mortality (P = 0.06) and major morbidity, except for a higher need for PMK (P = 0.03), as well as comparable mid-term survival (P = 0.89), freedom from AHF (P = 0.81), reinterventions (P = 0.63), stroke (P = 0.21) and thrombo-embolisms (P = 0.09). Urgent/emergent indication resulted in higher hospital death, LCOS, transfusions, MRCVCs, intra-aortic balloon pumping (IABP), stroke, prolonged (>48 h) ventilation, pneumonia, ARI, CRRT, lower mid-term survival and freedom from AHF (P ≤ 0.03). Preoperative NYHA functional Class IV correlated with higher LCOS, IABP, prolonged ventilation, pneumonia, ARF, ARI, CRRT and MRCVCs and lower mid-term survival, freedom from AHF, reinterventions and stroke (P ≤ 0.02). Endocarditis demonstrated higher hospital mortality, MRCVCs, LCOS, IABP, stroke, ARF, prolonged intubation, pneumonia, ARI, CRRT, transfusions and PMK and lower mid-term survival and freedom from AHF and reinterventions (P ≤ 0.04).
CONCLUSIONS
RAVR achieves overall satisfactory results. Baseline risk factors and perioperative complications strongly affect outcomes and mandate improvements in perioperative management. New emerging strategies might be considered in selected high-risk cases.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezu116</identifier><identifier>PMID: 24686001</identifier><language>eng</language><publisher>Germany: Oxford University Press</publisher><subject>Adult ; Aged ; Aortic Valve - surgery ; Endocarditis, Bacterial - surgery ; Europe ; Female ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation - methods ; Heart Valve Prosthesis Implantation - mortality ; Heart Valve Prosthesis Implantation - statistics & numerical data ; Humans ; Male ; Middle Aged ; Prosthesis-Related Infections - surgery ; Reoperation - methods ; Reoperation - mortality ; Reoperation - statistics & numerical data ; Treatment Outcome ; Young Adult</subject><ispartof>European journal of cardio-thoracic surgery, 2015-02, Vol.47 (2), p.269-280</ispartof><rights>The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2014</rights><rights>The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c357t-6d2683f8964b893a778c8023ddf1b43b34b5ac3da0babc32d5b681ebd6c9da553</citedby><cites>FETCH-LOGICAL-c357t-6d2683f8964b893a778c8023ddf1b43b34b5ac3da0babc32d5b681ebd6c9da553</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24686001$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Onorati, Francesco</creatorcontrib><creatorcontrib>Biancari, Fausto</creatorcontrib><creatorcontrib>De Feo, Marisa</creatorcontrib><creatorcontrib>Mariscalco, Giovanni</creatorcontrib><creatorcontrib>Messina, Antonio</creatorcontrib><creatorcontrib>Santarpino, Giuseppe</creatorcontrib><creatorcontrib>Santini, Francesco</creatorcontrib><creatorcontrib>Beghi, Cesare</creatorcontrib><creatorcontrib>Nappi, Giannantonio</creatorcontrib><creatorcontrib>Troise, Giovanni</creatorcontrib><creatorcontrib>Fischlein, Theodor</creatorcontrib><creatorcontrib>Passerone, Giancarlo</creatorcontrib><creatorcontrib>Heikkinen, Juni</creatorcontrib><creatorcontrib>Faggian, Giuseppe</creatorcontrib><title>Mid-term results of aortic valve surgery in redo scenarios in the current practice: results from the multicentre European RECORD (REdo Cardiac Operation Research Database) initiative</title><title>European journal of cardio-thoracic surgery</title><addtitle>Eur J Cardiothorac Surg</addtitle><description>OBJECTIVES
Although commonly reported as single-centre experiences, redo aortic valve replacement (RAVR) has overall acceptable results. Nevertheless, trans-catheter aortic valve replacement has recently questioned the efficacy of RAVR.
METHODS
Early-to-mid-term results and determinants of mortality in 711 cases of RAVR from seven European institutions were assessed in the entire population and in selected high-risk subgroups [elderly >75 years, urgent/emergent procedures, preoperative New York Heart Association (NYHA) functional Class IV and endocarditis].
RESULTS
Hospital mortality was 5.1%, major re-entry cardiovascular complications (MRCVCs) 4.9%, low cardiac output syndrome (LCOS) 15.3%, stroke 6.6%, acute respiratory failure (ARF) 10.6%, acute renal insufficiency (ARI) 19.3% and need for continuous renal replacement therapy (CRRT) 7.2%, transfusions 66.9% and for permanent pacemaker (PMK) 12.7%. Mid-term survival, freedom from acute heart failure (AHF), reinterventions, stroke and thrombo-embolisms were 77.2 ± 2.7, 84.4 ± 2.6, 97.2 ± 0.8, 97.2 ± 0.9 and 96.3 ± 1.2%, respectively; 87.5% of patients were in NYHA functional Class I–II. Preoperative left ventricular ejection fraction of <30% [odds ratio (OR) 8.7, 95% confidence interval (CI) 2.1–35.6], MRCVCs (OR 20.9, 95% CI 5.6–78.3), cardiopulmonary bypass time (OR 1.1, 95% CI 1.0–1.1), perioperative LCOS (OR 17.2, 95% CI 5.1–57.4) and ARI (OR 5.1, 95% CI 1.5–18.1) predicted hospital death. Endocarditis (OR 7.5, 95% CI 2.9–19.1), preoperative NYHA functional Class IV (OR 4.7, 95% CI 1.0–24.0), combined RAVR + mitral surgery (OR 5.1, 95% CI 1.5–17.3) and AHF at follow-up (OR 2.8, 95% CI 1.3–6.0) predicted late death at the Cox proportional hazard regression model. Elderly >75 years had similar hospital mortality (P = 0.06) and major morbidity, except for a higher need for PMK (P = 0.03), as well as comparable mid-term survival (P = 0.89), freedom from AHF (P = 0.81), reinterventions (P = 0.63), stroke (P = 0.21) and thrombo-embolisms (P = 0.09). Urgent/emergent indication resulted in higher hospital death, LCOS, transfusions, MRCVCs, intra-aortic balloon pumping (IABP), stroke, prolonged (>48 h) ventilation, pneumonia, ARI, CRRT, lower mid-term survival and freedom from AHF (P ≤ 0.03). Preoperative NYHA functional Class IV correlated with higher LCOS, IABP, prolonged ventilation, pneumonia, ARF, ARI, CRRT and MRCVCs and lower mid-term survival, freedom from AHF, reinterventions and stroke (P ≤ 0.02). Endocarditis demonstrated higher hospital mortality, MRCVCs, LCOS, IABP, stroke, ARF, prolonged intubation, pneumonia, ARI, CRRT, transfusions and PMK and lower mid-term survival and freedom from AHF and reinterventions (P ≤ 0.04).
CONCLUSIONS
RAVR achieves overall satisfactory results. Baseline risk factors and perioperative complications strongly affect outcomes and mandate improvements in perioperative management. New emerging strategies might be considered in selected high-risk cases.</description><subject>Adult</subject><subject>Aged</subject><subject>Aortic Valve - surgery</subject><subject>Endocarditis, Bacterial - surgery</subject><subject>Europe</subject><subject>Female</subject><subject>Heart Valve Prosthesis</subject><subject>Heart Valve Prosthesis Implantation - methods</subject><subject>Heart Valve Prosthesis Implantation - mortality</subject><subject>Heart Valve Prosthesis Implantation - statistics & numerical data</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prosthesis-Related Infections - surgery</subject><subject>Reoperation - methods</subject><subject>Reoperation - mortality</subject><subject>Reoperation - statistics & numerical data</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1DAUhSMEoqWwY428o0iE2nFiJ-zQdPiRikYagcQuurZvqKtJHK6dkcqD9fnqdkqXrPxzPn9X8imK14J_ELyTZ3hlUzzDv4sQ6klxLFotSy3rX0_zngte6q7mR8WLGK8450pW-nlxVNWqVZyL4-Lmu3dlQhoZYVx2KbIwMAiUvGV72O2RxYV-I10zP2XEBRYtTkA-xLubdInMLkQ4JTYT2PwMPz6qBgrjPTLmY06mRMjWC4UZYWLb9WqzPWen23W2roCcB8s2MxIkH3KMEYHsJTuHBAYivssDffI53ePL4tkAu4ivHtaT4ufn9Y_V1_Ji8-Xb6tNFaWWjU6lcpVo5tJ2qTdtJ0Lq1La-kc4MwtTSyNg1Y6YAbMFZWrjGqFWicsp2DppEnxenBO1P4s2BM_ejzB-x2MGFYYi9U3Witheoy-v6AWgoxEg79TH4Euu4F7--a6u-b6g9NZfzNg3kxI7pH-F81GXh7AMIy_191C1F4oj0</recordid><startdate>20150201</startdate><enddate>20150201</enddate><creator>Onorati, Francesco</creator><creator>Biancari, Fausto</creator><creator>De Feo, Marisa</creator><creator>Mariscalco, Giovanni</creator><creator>Messina, Antonio</creator><creator>Santarpino, Giuseppe</creator><creator>Santini, Francesco</creator><creator>Beghi, Cesare</creator><creator>Nappi, Giannantonio</creator><creator>Troise, Giovanni</creator><creator>Fischlein, Theodor</creator><creator>Passerone, Giancarlo</creator><creator>Heikkinen, Juni</creator><creator>Faggian, Giuseppe</creator><general>Oxford University Press</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>20150201</creationdate><title>Mid-term results of aortic valve surgery in redo scenarios in the current practice: results from the multicentre European RECORD (REdo Cardiac Operation Research Database) initiative</title><author>Onorati, Francesco ; Biancari, Fausto ; De Feo, Marisa ; Mariscalco, Giovanni ; Messina, Antonio ; Santarpino, Giuseppe ; Santini, Francesco ; Beghi, Cesare ; Nappi, Giannantonio ; Troise, Giovanni ; Fischlein, Theodor ; Passerone, Giancarlo ; Heikkinen, Juni ; Faggian, Giuseppe</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c357t-6d2683f8964b893a778c8023ddf1b43b34b5ac3da0babc32d5b681ebd6c9da553</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aortic Valve - surgery</topic><topic>Endocarditis, Bacterial - surgery</topic><topic>Europe</topic><topic>Female</topic><topic>Heart Valve Prosthesis</topic><topic>Heart Valve Prosthesis Implantation - methods</topic><topic>Heart Valve Prosthesis Implantation - mortality</topic><topic>Heart Valve Prosthesis Implantation - statistics & numerical data</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prosthesis-Related Infections - surgery</topic><topic>Reoperation - methods</topic><topic>Reoperation - mortality</topic><topic>Reoperation - statistics & numerical data</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Onorati, Francesco</creatorcontrib><creatorcontrib>Biancari, Fausto</creatorcontrib><creatorcontrib>De Feo, Marisa</creatorcontrib><creatorcontrib>Mariscalco, Giovanni</creatorcontrib><creatorcontrib>Messina, Antonio</creatorcontrib><creatorcontrib>Santarpino, Giuseppe</creatorcontrib><creatorcontrib>Santini, Francesco</creatorcontrib><creatorcontrib>Beghi, Cesare</creatorcontrib><creatorcontrib>Nappi, Giannantonio</creatorcontrib><creatorcontrib>Troise, Giovanni</creatorcontrib><creatorcontrib>Fischlein, Theodor</creatorcontrib><creatorcontrib>Passerone, Giancarlo</creatorcontrib><creatorcontrib>Heikkinen, Juni</creatorcontrib><creatorcontrib>Faggian, Giuseppe</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>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Onorati, Francesco</au><au>Biancari, Fausto</au><au>De Feo, Marisa</au><au>Mariscalco, Giovanni</au><au>Messina, Antonio</au><au>Santarpino, Giuseppe</au><au>Santini, Francesco</au><au>Beghi, Cesare</au><au>Nappi, Giannantonio</au><au>Troise, Giovanni</au><au>Fischlein, Theodor</au><au>Passerone, Giancarlo</au><au>Heikkinen, Juni</au><au>Faggian, Giuseppe</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mid-term results of aortic valve surgery in redo scenarios in the current practice: results from the multicentre European RECORD (REdo Cardiac Operation Research Database) initiative</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2015-02-01</date><risdate>2015</risdate><volume>47</volume><issue>2</issue><spage>269</spage><epage>280</epage><pages>269-280</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><abstract>OBJECTIVES
Although commonly reported as single-centre experiences, redo aortic valve replacement (RAVR) has overall acceptable results. Nevertheless, trans-catheter aortic valve replacement has recently questioned the efficacy of RAVR.
METHODS
Early-to-mid-term results and determinants of mortality in 711 cases of RAVR from seven European institutions were assessed in the entire population and in selected high-risk subgroups [elderly >75 years, urgent/emergent procedures, preoperative New York Heart Association (NYHA) functional Class IV and endocarditis].
RESULTS
Hospital mortality was 5.1%, major re-entry cardiovascular complications (MRCVCs) 4.9%, low cardiac output syndrome (LCOS) 15.3%, stroke 6.6%, acute respiratory failure (ARF) 10.6%, acute renal insufficiency (ARI) 19.3% and need for continuous renal replacement therapy (CRRT) 7.2%, transfusions 66.9% and for permanent pacemaker (PMK) 12.7%. Mid-term survival, freedom from acute heart failure (AHF), reinterventions, stroke and thrombo-embolisms were 77.2 ± 2.7, 84.4 ± 2.6, 97.2 ± 0.8, 97.2 ± 0.9 and 96.3 ± 1.2%, respectively; 87.5% of patients were in NYHA functional Class I–II. Preoperative left ventricular ejection fraction of <30% [odds ratio (OR) 8.7, 95% confidence interval (CI) 2.1–35.6], MRCVCs (OR 20.9, 95% CI 5.6–78.3), cardiopulmonary bypass time (OR 1.1, 95% CI 1.0–1.1), perioperative LCOS (OR 17.2, 95% CI 5.1–57.4) and ARI (OR 5.1, 95% CI 1.5–18.1) predicted hospital death. Endocarditis (OR 7.5, 95% CI 2.9–19.1), preoperative NYHA functional Class IV (OR 4.7, 95% CI 1.0–24.0), combined RAVR + mitral surgery (OR 5.1, 95% CI 1.5–17.3) and AHF at follow-up (OR 2.8, 95% CI 1.3–6.0) predicted late death at the Cox proportional hazard regression model. Elderly >75 years had similar hospital mortality (P = 0.06) and major morbidity, except for a higher need for PMK (P = 0.03), as well as comparable mid-term survival (P = 0.89), freedom from AHF (P = 0.81), reinterventions (P = 0.63), stroke (P = 0.21) and thrombo-embolisms (P = 0.09). Urgent/emergent indication resulted in higher hospital death, LCOS, transfusions, MRCVCs, intra-aortic balloon pumping (IABP), stroke, prolonged (>48 h) ventilation, pneumonia, ARI, CRRT, lower mid-term survival and freedom from AHF (P ≤ 0.03). Preoperative NYHA functional Class IV correlated with higher LCOS, IABP, prolonged ventilation, pneumonia, ARF, ARI, CRRT and MRCVCs and lower mid-term survival, freedom from AHF, reinterventions and stroke (P ≤ 0.02). Endocarditis demonstrated higher hospital mortality, MRCVCs, LCOS, IABP, stroke, ARF, prolonged intubation, pneumonia, ARI, CRRT, transfusions and PMK and lower mid-term survival and freedom from AHF and reinterventions (P ≤ 0.04).
CONCLUSIONS
RAVR achieves overall satisfactory results. Baseline risk factors and perioperative complications strongly affect outcomes and mandate improvements in perioperative management. New emerging strategies might be considered in selected high-risk cases.</abstract><cop>Germany</cop><pub>Oxford University Press</pub><pmid>24686001</pmid><doi>10.1093/ejcts/ezu116</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1010-7940 |
| ispartof | European journal of cardio-thoracic surgery, 2015-02, Vol.47 (2), p.269-280 |
| issn | 1010-7940 1873-734X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1645777169 |
| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Aged Aortic Valve - surgery Endocarditis, Bacterial - surgery Europe Female Heart Valve Prosthesis Heart Valve Prosthesis Implantation - methods Heart Valve Prosthesis Implantation - mortality Heart Valve Prosthesis Implantation - statistics & numerical data Humans Male Middle Aged Prosthesis-Related Infections - surgery Reoperation - methods Reoperation - mortality Reoperation - statistics & numerical data Treatment Outcome Young Adult |
| title | Mid-term results of aortic valve surgery in redo scenarios in the current practice: results from the multicentre European RECORD (REdo Cardiac Operation Research Database) initiative |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-10T19%3A43%3A32IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Mid-term%20results%20of%20aortic%20valve%20surgery%20in%20redo%20scenarios%20in%20the%20current%20practice:%20results%20from%20the%20multicentre%20European%20RECORD%20(REdo%20Cardiac%20Operation%20Research%20Database)%20initiative&rft.jtitle=European%20journal%20of%20cardio-thoracic%20surgery&rft.au=Onorati,%20Francesco&rft.date=2015-02-01&rft.volume=47&rft.issue=2&rft.spage=269&rft.epage=280&rft.pages=269-280&rft.issn=1010-7940&rft.eissn=1873-734X&rft_id=info:doi/10.1093/ejcts/ezu116&rft_dat=%3Cproquest_cross%3E1645777169%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1645777169&rft_id=info:pmid/24686001&rft_oup_id=10.1093/ejcts/ezu116&rfr_iscdi=true |