Do postoperative hemodynamic parameters add prognostic value for mortality after surgical aortic valve replacement?

JTCVS Open, vol. 17, pp. 47–54

Abstract

Background: Although various hemodynamic parameters to assess prosthetic performance are available, prosthesis-patient mismatch (PPM) is defined exclusively by effective orifice area (EOA) index thresholds. Adjusting for the Society of Thoracic Surgeons predicted risk of mortality (STS PROM), we aimed to explore the added value of postoperative hemodynamic parameters for the prediction of all-cause mortality at 5 years after aortic valve replacement. Methods: Data were obtained from the Pericardial Surgical Aortic Valve Replacement (PERIGON) Pivotal Trial, a multicenter prospective cohort study examining the performance of the Avalus bioprosthesis. Candidate predictors were assessed at the first follow-up visit; patients who had no echocardiography data, withdrew consent, or died before this visit were excluded. Candidate predictors included peak jet velocity, mean pressure gradient, EOA, predicted and measured EOA index, Doppler velocity index, indexed internal prosthesis orifice area, and categories for PPM. The performance of Cox models was investigated using the c-statistic and net reclassification improvement (NRI), among other tools. Results: A total of 1118 patients received the study valve, of whom 1022 were eligible for the present analysis. In univariable analysis, STS PROM was the sole significant predictor of all-cause mortality (hazard ratio, 1.40; 95% confidence interval, 1.26-1.55). When extending the STS PROM with single hemodynamic parameters, neither the c-statistics nor the NRIs demonstrated added prognostic value compared to a model with STS PROM alone. Similar findings were observed when multiple hemodynamic parameters were added. Conclusions: The STS PROM was found to be the main predictor of patient prognosis. The additional prognostic value of postoperative hemodynamic parameters for the prediction of all-cause mortality was limited.

Authors 10

1. Bart J.J. Velders corresponding Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands

2. Michiel D. Vriesendorp Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands

3. Federico M. Asch

   MedStar Health Research Institute

   Affiliation as printed

   Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington, DC

   Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington DC, USA

4. François Dagenais

   Institut universitaire de cardiologie et de pneumologie de Québec

   Affiliation as printed

   Division of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Quebec, Canada

5. Rüdiger Lange

   Deutsches Herzzentrum München

   Affiliation as printed

   Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany

6. Michael J. Reardon

   Houston Methodist

   Affiliation as printed

   Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex

   Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA

7. Vivek Rao

   Toronto General Hospital

   Affiliation as printed

   Department of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada

   Department of Cardiovascular Surgery, Toronto General Hospital, Toronto, Canada

8. Joseph F. Sabik Aachen Department of Cardiothoracic Surgery

   Leiden University · University Hospitals of Cleveland · Leiden University Medical Center · Case Western Reserve University

   Affiliation as printed

   Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio

   Abbott Medical, Boston Scientific, Gore Medical,

   Department of Cardiothoracic Surgery, Leiden University Medical Centre, Albinusdreef 2, Leiden, Zuid-Holland 2333 ZA, The Netherlands

9. Rolf H. H. Groenwold Aachen Department of Biomedical Data Science Department of Clinical Epidemiology Departments of Clinical Epidemiology and Biomedical Data Science

   Leiden University Medical Center

   Affiliation as printed

   Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands

   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

   Departments of Clinical Epidemiology and Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands

10. Robert J.M. Klautz Aachen Department of Cardiothoracic Surgery

    Leiden University Medical Center

    Affiliation as printed

    Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands